Individual provider Active NPI

Dathao Huynh

  • Family Nurse Practitioner
  • Ellicott City, MD
National Provider Identifier
1285268300
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R225185 Issued in MD
Practice address
4801 Dorsey Hall Dr Ste 140
Ellicott City, MD 21042-7703
Phone
(410) 992-4100
NPI assigned
Feb 27, 2020
Last updated
Feb 27, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R225185 MD Primary

Addresses

Primary practice location

4801 Dorsey Hall Dr Ste 140
Ellicott City, MD 21042-7703

Mailing address

9716 Summer Park CT
Columbia, MD 21046-1808
Phone (609) 892-5972

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211209000966 MD Practitioner - Nurse Practitioner 4082004825 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R225185MDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medical and Aesthetic Dermatology CurrentSince May 1, 2023 Accepting new patients
Lauring Dermatology LLC CurrentSince Apr 4, 2022 Accepting new patients
Wellave, LLC CurrentSince Nov 1, 2022 Accepting new patients
Privia Care Center LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

116 Defense Hwy
Ste 102
Annapolis, MD 21401
Phone (410) 897-1961

9256 Bendix Rd
Ste 200A
Columbia, MD 21045
Phone (443) 201-1603

198 Thomas Johnson Dr
Ste 8
Frederick, MD 21702
Phone (301) 663-8707

415 Williams Ct
Ste 116
Middle River, MD 21220
Phone (410) 665-3093

7642 Belair Rd
Nottingham, MD 21236
Phone (410) 665-3093

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFJEBA

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1582761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1285268300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9716 SUMMER PARK CT",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210461808",
            "telephone_number": "609-892-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR STE 140",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427703",
            "telephone_number": "410-992-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUYNH",
        "first_name": "DATHAO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-27",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R225185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

Verify at the official NPI Registry.