Delmarva Skin PA
Organization Active NPI Dermatology Physician · Selbyville, DE
NPI 1255818522 · NPPES record last updated Nov 29, 2023
Key facts
- NPI
- 1255818522
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- C1-0011369 (DE)
- Legal business name
- DELMARVA SKIN PA
- Practice address
- 38394 Dupont Blvd Unit FG
Selbyville, DE 19975-3049 - Phone
- (302) 564-0001
- NPI assigned
- Jul 19, 2018
- Organization subpart
- No
Authorized official
- Name
- Dr. Sara Moghaddam, MD
- Title
- Physician
- Phone
- (302) 564-0001
Practitioners 2
-
Sara Moghaddam, M.D.
-
Curtis Dane Asbury, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 08D2111454 | Delmarva Skin PA | Compliance | Jul 29, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DE
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181026000348 | DE | Part B Supplier - Clinic/Group Practice | 6103179809 |
Receives reassigned benefits from 2 practitioners Practice locations: Selbyville, DE |
National Provider Directory
Locations
38394 DuPont Blvd
Ste Fg
Selbyville, DE 19975
Phone (302) 564-0001
38394 DuPont Blvd
Unit Fg
Selbyville, DE 19975
Phone (302) 564-0001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | C1-0011369 | DE | Yes |
Addresses
Primary practice location
38394 Dupont Blvd Unit FG
Selbyville, DE 19975-3049
Mailing address
38394 Dupont Blvd Unit F&G
Selbyville, DE 19975-3049
Phone (302) 564-0001
Other providers in Selbyville, DE
- Rhonda Crenshaw
- Rosalyn Daisey
- Daws Mental Health Counseling
- Lindsay Jones Daws
- Delaware CVS Pharmacy, L.L.C.
- Gwendolyn Devivo
- Sarah Katelyn Dibuo
- Sally Hamel Dowling
- Gloria Duffy
- Dynamic Therapy Services, LLC
All providers in Selbyville, DE · Dermatology Physician in Delaware
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.