NPIMap

Organization Active NPI

Frederick Dermatology Associates LLC

  • Dermatology Physician
  • Frederick, MD
National Provider Identifier
1649435694
Registry record updated Oct 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FREDERICK DERMATOLOGY ASSOCIATES LLC
Practice address
45 Thomas Johnson Dr
Frederick, MD 21702-4425
Phone
(301) 928-2105
NPI assigned
Jul 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2008

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

Authorized official

Name
Dr. Kevin P Hogan, MD
Title
Partner
Phone
(301) 928-2105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

45 Thomas Johnson Dr
Frederick, MD 21702-4425

Mailing address

45 Thomas Jefferson Drive
Suite 209
Frederick, MD 21702-4425
Phone (301) 928-2105

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081126000564 MD Part B Supplier - Clinic/Group Practice 3678633203 Receives reassigned benefits from 8 practitioners
Practice locations: Frederick, MD

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D1092736Frederick Dermatology Associates LLC45 Thomas Johnson Drive, Suite 209, Frederick, MD 21702ComplianceFeb 2, 2027

National Provider Directory

National Provider Directory

Locations

45 Thomas Johnson Dr
Frederick, MD 21702
Phone (202) 660-5555

45 Thomas Johnson Dr
Ste 209
Frederick, MD 21702
Phone (301) 662-6755

Practitioners & affiliated clinicians

Practitioners 8

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": "1216339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1649435694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 THOMAS JEFFERSON DRIVE",
            "address_2": "SUITE 209",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024425",
            "telephone_number": "301-928-2105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 THOMAS JOHNSON DR",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024425",
            "telephone_number": "301-928-2105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICK DERMATOLOGY ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-18",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "HOGAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "301-928-2105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; 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.