Modern Dermatology of Maryland, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MODERN DERMATOLOGY OF MARYLAND, LLC

Practice address

2568A Riva Rd Ste 102
Annapolis, MD 21401-7457

Phone

(410) 216-0993

NPI assigned

Aug 12, 2022

Last updated

Dec 3, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lane Alexander Neidig, MDNPI 1851779573

Title

Managing Member

Phone

(410) 216-0993

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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.

• Lane Neidig, MD

  • Dermatology Physician
  • Annapolis, MD
  • NPI 1851779573
  Medicare reassignment Care Compare group NPD Authorized official
• Samantha Consoli

  • Physician Assistant
  • Baltimore, MD
  • NPI 1487253738
  Medicare reassignment Care Compare group
• Ankit Agarwal, M.D.

  • Radiation Oncology Physician
  • San Antonio, TX
  • NPI 1629430376

  MD

  Medicare reassignment NPD
• Cara Elizabeth Arcidiacono, PA-C

  • Physician Assistant
  • Annapolis, MD
  • NPI 1801238902
  NPD

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

{
    "created_epoch": "1660262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1619605078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2568A RIVA RD STE 102",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017457",
            "telephone_number": "410-216-0993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2568A RIVA RD STE 102",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017457",
            "telephone_number": "410-216-0993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY OF MARYLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-12",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "NEIDIG",
        "authorized_official_first_name": "LANE",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "410-216-0993",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Alan Mitchell, M.D., PA
• Susan Mitchell, PTGCS
• Victoria Ann Mitchell, MED, MPT
• Ilana Mittman
• MKM Home Care, LLC (Right at Home Annapolis)
• Jitendrakumar Rajnikant Modi, M.D.
• Kim Modica
• Lyle Terrence Modlin, D.P.M.
• Milan Pankaj Mody, P.A.
• Jeannine Mogavero Theoret, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.