Provider Demographics
NPI:1992930713
Name:MARYLAND DERMATOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:MARYLAND DERMATOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JURIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:GERMANAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-829-4185
Mailing Address - Street 1:1502 S MAIN ST STE 304
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-5374
Mailing Address - Country:US
Mailing Address - Phone:301-829-4185
Mailing Address - Fax:301-829-4187
Practice Address - Street 1:1502 S MAIN ST STE 304
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5374
Practice Address - Country:US
Practice Address - Phone:301-829-4185
Practice Address - Fax:301-829-4187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty