Organization Active NPI

Cecil Dermatology LLC

  • Plastic Surgery Physician
  • Elkton, MD
National Provider Identifier
1427190982
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
D0053034 Issued in MD
Legal business name
CECIL DERMATOLOGY LLC
Practice address
304 North St Ste 3
Elkton, MD 21921-5570
Phone
(410) 620-9722
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Authorized official

Name
Cindy Groux
Title
Billing Manager
Phone
(302) 633-5840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X D0053034 MD Primary

Addresses

Primary practice location

304 North St Ste 3
Elkton, MD 21921-5570

Mailing address

304 North St Ste 3
Elkton, MD 21921-5570
Phone (410) 620-9722

Other identifiers 2

IdentifierTypeStateIssuer
DC3411OtherMDMEDICARE RAILROAD
DC3411OtherMDMCR RAILROAD PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070402000410 MD Part B Supplier - Clinic/Group Practice 4385748219 Receives reassigned benefits from 1 practitioner
Practice locations: Elkton, MD

National Provider Directory

National Provider Directory

Locations

111 W High St
Ste 105
Elkton, MD 21921
Phone (410) 398-7797

304 North St
Ste 3
Elkton, MD 21921
Phone (410) 620-9722

111 W High St
#105
Elkton, MD 21921
Phone (410) 620-3734

360 E Pulaski Hwy
Fl 3
Elkton, MD 21921
Phone (410) 620-9722

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652659200000",
    "number": "1427190982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 NORTH ST STE 3",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215570",
            "telephone_number": "410-620-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 NORTH ST STE 3",
            "city": "ELKTON",
            "state": "MD",
            "postal_code": "219215570",
            "telephone_number": "410-620-9722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CECIL DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A",
        "authorized_official_last_name": "GROUX",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "302-633-5840"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "MD",
            "license": "D0053034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DC3411",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR RAILROAD PIN",
            "identifier": "DC3411",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elkton, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; 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.