AESTHETIC DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER (NPI# 1104068790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104068790 |
| Entity Type | Organization |
| Organization Name | AESTHETIC DERMATOLOGY AND DERMATOLOGIC SURGERY CENTER |
| Practice Address |
4321 Collington Rd Suite 230 Bowie MD 20716 |
| Mailing Address |
4321 Collington Rd Suite 230 Bowie MD 20716-2259 |
| Practice Telephone | 3018094321 |
| Practice Fax Number | 3018095798 |
| Mailing Telephone | 3018094321 |
| Mailing Fax Number | 3018095798 |
| Enumeration Date | 2009-03-30 |
| Last Update Date | 2018-08-27 |
| Authorized Official Name | DEBRA A COATS-WALTON (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3018094321 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | D0051777 | MD | Other Service Providers |
| Street Address |
4321 COLLINGTON RD SUITE 230 |
| City | BOWIE |
| State | MD |
| Zip Code | 20716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013171883 | Monica Boyden Francis | Physician Assistant | 4321 Collington Rd, Suite 230, Bowie, MD 20716-2259 | 2008-07-10 |
| 1699235531 | Kimberly Campbell Mcclendon | Nurse Practitioner | 4321 Collington Rd, Bowie, MD 20716-2259 | 2019-03-25 |
| 1083054654 | Javod Kazemizadeh Gol | Dentist | 4321 Collington Rd, Bowie, MD 20716-2259 | 2013-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508330903 | Stacey Katheryn Lundquist | Counselor | 3060 Michellville Rd, Suite 106, Bowie, MD 20716 | 2019-01-18 |
| 1427528819 | Nicole Rudd | Counselor | 4315 Northview Dr, Bowie, MD 20716 | 2018-11-28 |
| 1427541838 | Outreach Recovery II, LLC | Internal Medicine | 4201 Northview Dr Ste 104, Bowie, MD 20716 | 2018-06-11 |
| 1487143608 | Fatimata Koroma | Counselor | 3953 Elite St, Bowie, MD 20716 | 2018-05-02 |
| 1043739618 | Breanna Collinson | Behavior Technician | 3017 New Oak Ln., Bowie, MD 20716 | 2017-09-15 |
| 1790202000 | Sierra Williams Howell | Nurse Practitioner | 2802 Eliston Street, Bowie, MD 20716 | 2017-08-28 |
| 1487175105 | Martine Jean | Technician | 15911 Pointer Ridge Rd, Bowie, MD 20716 | 2017-07-03 |
| 1902254493 | Olachi Enwerem | Licensed Practical Nurse | 16206 Audubon Lane, Bowie, MD 20716 | 2016-05-25 |
| 1780039230 | Debra Lachaune Garris | Specialist | 3042 Mitchiville Road, Bowie, MD 20716 | 2016-05-03 |
| 1750782553 | Medical Trasportation Systems LLC | Non-emergency Medical Transport (VAN) | 16036 Elegant Ave, Bowie, MD 20716 | 2014-09-11 |
| Find all providers in zip 20716 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710525159 | Nikita Robinson | Specialist | 12743 Millstream Dr, Bowie, MD 20715-1636 | 2019-12-17 |
| 1528577913 | Laurenee Gauvin-cox | Specialist | 11019 Lake Victoria Ln, Bowie, MD 20720-4272 | 2017-09-28 |
| 1780039230 | Debra Lachaune Garris | Specialist | 3042 Mitchiville Road, Bowie, MD 20716 | 2016-05-03 |
| 1114234978 | A,d. Goldsborough & Associates | Specialist | 15606 Everglade Ln # C301, Bowie, MD 20716-3260 | 2010-08-31 |
| 1497931034 | Amee Marcine Roland | Specialist | 2481 Prospect Rd, Bowie, TX 76230-7404 | 2008-01-14 |
| 1659381127 | Angela Harrison Brantley | Specialist | 3540 Crain Hwy # 500, Bowie, MD 20716-1303 | 2006-08-08 |
| 1346754264 | Healthy Connections Bowie | Specialist | 4000 Mitchellville Rd Ste B322, Bowie, MD 20716-3176 | 2017-11-30 |
| 1619378890 | Pharmacy & Pharmaceutical Services Provider | Specialist | 13202 Steeplechase Dr, Bowie, MD 20715-4542 | 2014-09-08 |
| 1427340397 | D H Cho & Y H Cho Md PC | Specialist | 14999 Health Center Dr, Bowie, MD 20716-1074 | 2011-05-10 |
| 1760789184 | Cardiology Associate, LLC | Specialist | 4175 N Hanson Ct, Suite 100, Bowie, MD 20716-3179 | 2011-02-21 |
| Find all providers in BOWIE | ||||
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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.