NPIMap

Organization Active NPI

Advanced Dermatology of Maryland PC

  • Dermatology Physician
  • Fort Washington, MD
National Provider Identifier
1386479004
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY OF MARYLAND PC
Practice address
11701 Livingston Rd Ste 302
Fort Washington, MD 20744-5146
Phone
(301) 292-6010
NPI assigned
Sep 3, 2024
Last updated
Sep 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANCED DERMATOLOGY OF MARYLAND PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Matt Louis Leavitt, DONPI 1821108341
Title
Owner
Phone
(407) 875-2080

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

11701 Livingston Rd Ste 302
Fort Washington, MD 20744-5146

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (407) 875-2080

Other identifiers 1

IdentifierTypeStateIssuer
8025029MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161216000688 DC Part B Supplier - Clinic/Group Practice 9931489804 Receives reassigned benefits from 29 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockville, MD; Oxon Hill, MD; Olney, MD; Ft Washington, MD

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Advanced Dermatology MD PC

Locations

5411 W Cedar Ln
Ste 102A
Bethesda, MD 20814
Phone (301) 530-3396

10153 York Rd
Ste 104
Hunt Valley, MD 21030
Phone (410) 472-0901

174 Waterfront St
Ste 200
Oxon Hill, MD 20745
Phone (240) 493-8447

1838 Greene Tree Rd
Ste 340
Pikesville, MD 21208
Phone (410) 602-3376

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 52

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.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1386479004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "407-875-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11701 LIVINGSTON RD STE 302",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207445146",
            "telephone_number": "301-292-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF MARYLAND PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DERMATOLOGY OF MARYLAND PC",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-875-2080",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8025029",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washington, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.