Provider Demographics
NPI:1215061759
Name:COMPREHENSIVE DERMATOLOGY CENTER, P.C
Entity type:Organization
Organization Name:COMPREHENSIVE DERMATOLOGY CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:XUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:301-869-2126
Mailing Address - Street 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-869-2126
Mailing Address - Fax:301-869-2127
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-869-2126
Practice Address - Fax:301-869-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH39246Medicare UPIN
MDG01236Medicare ID - Type Unspecified