NPIMap

Organization Active NPI

Shah Dermatology LLC

  • Dermatology Physician
  • Waldorf, MD
National Provider Identifier
1023821592
Registry record updated Feb 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SHAH DERMATOLOGY LLC
Practice address
10 Saint Patrick's Drive
Specialties II 3Rd Floor
Waldorf, MD 20603-4572
Phone
(240) 448-2970
Fax
(301) 638-7257
NPI assigned
Jan 29, 2025
Last updated
Feb 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Melissa Norris
Title
Credentialing Coordinator
Phone
(301) 373-7318

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

10 Saint Patrick's Drive
Specialties II 3Rd Floor
Waldorf, MD 20603-4572

Mailing address

PO Box 640
Hollywood, MD 20636-0640
Phone (240) 448-2970

Other names 1

  • Shah Dermatology LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Shah Dermatology LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1023821592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "HOLLYWOOD",
            "state": "MD",
            "postal_code": "206360640",
            "telephone_number": "240-448-2970",
            "fax_number": "301-638-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 SAINT PATRICK'S DRIVE",
            "address_2": "SPECIALTIES II 3RD FLOOR",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034572",
            "telephone_number": "240-448-2970",
            "fax_number": "301-638-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAH DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "301-373-7318"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shah Dermatology LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Shah Dermatology LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.