MID ATLANTIC SKIN SURGERY INSTITUTE (NPI# 1043457468) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043457468 |
| Entity Type | Organization |
| Organization Name | MID ATLANTIC SKIN SURGERY INSTITUTE |
| Practice Address |
173 Saint Patricks Dr Suite 201 Waldorf MD 20603-5529 |
| Mailing Address |
26840 Point Lookout Road Po Box 1409 Leonardtown MD 20650-1409 |
| Practice Telephone | 3014758091 |
| Practice Fax Number | 3014726712 |
| Mailing Telephone | 3014758091 |
| Mailing Fax Number | 3014756712 |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |
| Authorized Official Name | DR. KANNARKAT VERGHESE (OWNER) |
| Authorized Official Telephone | 3014758091 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
D0065320 | MD | Allopathic & Osteopathic Physicians |
| Street Address |
173 SAINT PATRICKS DR SUITE 201 |
| City | WALDORF |
| State | MD |
| Zip Code | 20603-5529 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942477559 | Rosemary Joseph Verghese | Dermatology | 173 Saint Patricks Dr, Suite 201, Waldorf, MD 20603-5529 | 2008-05-13 |
| 1619359213 | St. Charles Family Dental | Dentist | 173 Saint Patricks Dr, Suite 204, Waldorf, MD 20603-5529 | 2015-06-19 |
| 1376815407 | April A. Ashe | Dentist | 173 Saint Patricks Dr, Suite 204, Waldorf, MD 20603-5529 | 2012-02-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437764214 | Kelly Weaver | Nurse Practitioner | 11315 Pembroke Square, 110, Waldorf, MD 20603 | 2020-09-09 |
| 1962937839 | Alexis Nicole Smith | Specialist/Technologist | 6115 Tapir Pl, Waldorf, MD 20603 | 2017-04-27 |
| 1235585472 | Msb Counseling Services, Inc | Counselor | 1282 Smallwood Drive W, Suite 460, Waldorf, MD 20603 | 2016-05-06 |
| 1619390325 | Tara Wood | Nurse Practitioner | 3070crain Highway, Waldorf, MD 20603 | 2014-01-31 |
| 1649603424 | Lauren Ashley White | Speech-Language Pathologist | 10810 Winchester Street Apt127, Waldorf, MD 20603 | 2013-08-15 |
| 1477810067 | Johnathan Vital | Clinical Neuropsychologist | 2413 Altenburg Ct, Waldorf, MD 20603 | 2012-04-19 |
| 1831480615 | Tara Marie Adams | Physical Therapist | 11340 Pembrooke Sq Ste 211, Waldorf, MD 20603 | 2011-04-27 |
| 1891007662 | Tanuja Katta | Pharmacist | 3385 Crain High Way, Rite Aid 11197, Waldorf, MD 20603 | 2010-07-09 |
| 1962725697 | Rhonda Bumpers-bland | Occupational Therapist | 2945 Fern Hill Place, Waldorf, MD 20603 | 2010-03-09 |
| 1265672901 | Shannon L Hamm | Counselor | 6126 Gray Wolf Court, Waldorf, MD 20603 | 2009-02-20 |
| Find all providers in zip 20603 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891267936 | Beckley Dermatology Inc. | Dermatology | 1110 Professional Ct Ste 201, Hagerstown, MD 21740-5945 | 2018-12-31 |
| 1518480136 | Forefront Dermatology, S.c. | Dermatology | 8134 Old Georgetown Rd, Bethesda, MD 20814 | 2017-07-25 |
| 1407014913 | Zaineb H Makhzoumi | Dermatology | 419 West Redwood Street, Suite 260, Baltimore, MD 21201 | 2008-05-30 |
| 1003002163 | Charles County Surgical Associates, LLC | Dermatology | 4225 Altamont Pl Unit 3, White Plains, MD 20695-3063 | 2007-09-21 |
| 1164458873 | Eric Finzi | Dermatology | 7701 Greenbelt Rd, 504, Greenbelt, MD 20770-2037 | 2006-06-24 |
| 1982670980 | Andrew Denis Montemarano | Dermatology | 6410 Rockledge Drive, Suite 300, Bethesda, MD 20817-7811 | 2006-02-28 |
| 1720059736 | David S Mezebish | Dermatology | 9711 Medical Center Dr Ste 307, Rockville, MD 20850-3385 | 2006-01-28 |
| 1942282371 | Michael Rebert Warner | Dermatology | 63 Thomas Johnson Dr, Suite B, Frederick, MD 21702-4384 | 2005-11-21 |
| 1659900850 | Cronin Dermatology and Skin Cancer | Dermatology | 5530 Wisconsin Ave Ste 1418, Chevy Chase, MD 20815-4302 | 2020-04-08 |
| 1821582917 | Charles B Toner Md Pa | Dermatology | 9131 Piscataway Rd Ste 550, Clinton, MD 20735 | 2018-06-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.