Radiance Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

RADIANCE DERMATOLOGY LLC

Practice address

10215 Fernwood Rd Ste 414
Bethesda, MD 20817-1191

Phone

(301) 430-4000

Fax

(301) 430-4040

NPI assigned

Jun 10, 2019

Organization subpart

No

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

Authorized official

Name

Omolara Olowoyeye, MDNPI 1760703193

Title

Owner

Phone

(301) 430-4000

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Omolara M Olowoyeye, M.D.

  • Dermatology Physician
  • Bethesda, MD
  • NPI 1760703193

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1184283640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10215 FERNWOOD RD STE 414",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171191",
            "telephone_number": "301-430-4000",
            "fax_number": "301-430-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10215 FERNWOOD RD STE 414",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171191",
            "telephone_number": "301-430-4000",
            "fax_number": "301-430-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANCE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "OLOWOYEYE",
        "authorized_official_first_name": "OMOLARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-430-4000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "D0081771",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karalyn Rabin, RN
• Sarah Elizabeth Rabin, MD
• Rachel Brumberger, LLC
• David Rad, DMD
• Rachel Kathryn Radcliffe, MS, OTR/L, IBCLC
• Radiology Associates of Maryland, LLC
• Ramy John Radmanesh, DDS
• Bartholomew Radolinski, M.D.
• Jason Scott Radowsky, MD
• Mark Raffeld

• Dermatology Physician in Bethesda, MD
• Providers in Bethesda, MD by specialty
• Dermatology Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.