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Export Provider Record NPI 1104068790
Aesthetic Dermatology And Dermatologic Surgery Center
Organization Subpart: NO
Active
NPI Number1104068790
NPI TypeNPI-2 Organization
SpecialtySpecialist
Provider Details
NPI1104068790
NPI TypeNPI-2 Organization
StatusActive
Enumeration Date2009-03-30
Last Updated2018-08-27
Authorized OfficialDebra Coats-Walton
Medical Director
Phone: 3018094321
Mailing Address4321 Collington Rd, Suite 230
Bowie, MD 20716-2259
United States
Phone: (301) 809-4321 | Fax: (301) 809-5798
📍 View Map
Primary Practice Address4321 Collington Rd, Suite 230
Bowie, MD 20716
United States
Phone: (301) 809-4321 | Fax: (301) 809-5798
📍 View Map
Taxonomy / Specialty
PrimaryTaxonomy Code & DescriptionStateLicense Number
Yes174400000X – SpecialistMDD0051777
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About NPI 1104068790

Aesthetic Dermatology And Dermatologic Surgery Center is an organization registered in the CMS NPPES NPI Registry with NPI number 1104068790. The primary specialty listed is Specialist. The organization is located in Bowie, MD. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2009-03-30. All data is sourced directly from the official CMS NPPES public API and is updated daily.

Frequently Asked Questions

What is NPI 1104068790?

NPI 1104068790 belongs to Aesthetic Dermatology And Dermatologic Surgery Center, a Specialist in Bowie, MD. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.

Is NPI 1104068790 active?

The current status of NPI 1104068790 in the NPPES registry is Active. The record was last updated on 2018-08-27.

What specialty is NPI 1104068790?

NPI 1104068790 is classified under the taxonomy Specialist. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.

How do I verify NPI 1104068790?

You can verify NPI 1104068790 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.

What address is on file for NPI 1104068790?

The primary practice address on file for NPI 1104068790 is 4321 Collington Rd, Bowie, MD 20716. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.

When was NPI 1104068790 issued?

NPI 1104068790 was first issued (enumerated) on 2009-03-30. The NPPES record was last updated on 2018-08-27.

Practice Location Map

Aesthetic Dermatology And Dermatologic Surgery Center is located at 4321 Collington Rd, Bowie, MD. Use the map below to find directions or verify the practice location.

📍 4321 Collington Rd, Bowie, MD 20716  ·  Open in Google Maps ↗

Related Healthcare Providers

The following providers share the same practice location, specialty, or state as Aesthetic Dermatology And Dermatologic Surgery Center. All records sourced from the CMS NPPES registry.

License Information

The following state license numbers are on file in the NPPES registry for NPI 1104068790. For license status verification, contact the relevant state licensing board directly.

Specialty / TaxonomyLicense NumberState
SpecialistD0051777MD
Data Verified from CMS NPPES Last synced: 2026-06-25 · Source: npiregistry.cms.hhs.gov · 45 CFR Part 162