NPIMap

Organization Active NPI

Montgomery Dermatology Associates, LLC

  • Medical Specialty Clinic/Center
  • Rockville, MD
National Provider Identifier
1083012355
Registry record updated Dec 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
D0042867 Issued in MD
Legal business name
MONTGOMERY DERMATOLOGY ASSOCIATES, LLC
Practice address
15225 Shady Grove Rd
Ste. 303
Rockville, MD 20850-3254
Phone
(301) 216-2980
Fax
(301) 216-2982
NPI assigned
Dec 18, 2014
Last updated
Dec 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2014

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

Authorized official

Name
Dr. Walter J Giblin, M.D.NPI 1831276757
Title
Member / Owner
Phone
(301) 216-2983

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X D0042867 MD Primary

Addresses

Primary practice location

15225 Shady Grove Rd
Ste. 303
Rockville, MD 20850-3254

Mailing address

15225 Shady Grove Rd
Ste. 303
Rockville, MD 20850-3254
Phone (301) 216-2980

National Provider Directory

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": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418860800000",
    "number": "1083012355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15225 SHADY GROVE RD",
            "address_2": "STE. 303",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503254",
            "telephone_number": "301-216-2980",
            "fax_number": "301-216-2982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15225 SHADY GROVE RD",
            "address_2": "STE. 303",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503254",
            "telephone_number": "301-216-2980",
            "fax_number": "301-216-2982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY DERMATOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-18",
        "last_updated": "2014-12-18",
        "status": "A",
        "authorized_official_last_name": "GIBLIN",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEMBER / OWNER",
        "authorized_official_telephone_number": "301-216-2983",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "MD",
            "license": "D0042867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2014; 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.