NPIMap

Organization Active NPI

University of Maryland Dermatologists PA

  • Dermatology Physician
  • Lutherville, MD
National Provider Identifier
1104623867
Registry record updated Feb 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Practice address
1447 York Rd Ste 102
Lutherville, MD 21093-6017
Phone
(667) 214-1171
NPI assigned
Feb 28, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2025

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

Authorized official

Name
Shavonda L Williams
Title
Corporate Director Professional Fee
Phone
(667) 214-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

1447 York Rd Ste 102
Lutherville, MD 21093-6017

Mailing address

250 W Pratt St Ste 900
Baltimore, MD 21201-6808

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000770 MD Part B Supplier - Clinic/Group Practice 7810888484 Receives reassigned benefits from 21 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Lutherville, MD; Ellicott City, MD; Chestertown, MD; Columbia, MD

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
University of Maryland Dermatologists PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

NPI Registry JSON

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

{
    "created_epoch": "1740700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740700800000",
    "number": "1104623867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W PRATT ST STE 900",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212016808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 YORK RD STE 102",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936017",
            "telephone_number": "667-214-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MARYLAND DERMATOLOGISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-28",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "SHAVONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CORPORATE DIRECTOR PROFESSIONAL FEE",
        "authorized_official_telephone_number": "667-214-2500"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.