NPIMap

Organization Active NPI

Visage Dermatology and Aesthetic Center, LLC

  • Dermatology Physician
  • Largo, MD
National Provider Identifier
1669716395
Registry record updated Dec 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
D0065513 Issued in MD
Legal business name
VISAGE DERMATOLOGY AND AESTHETIC CENTER, LLC
Practice address
1400 Mercantile LN
Suite 110
Largo, MD 20774-5341
Phone
(240) 223-3533
Fax
(240) 465-4800
NPI assigned
Nov 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2012

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

Authorized official

Name
Dr. Sharleen St. Surin-Lord, M.D.NPI 1023288156
Title
Medical Director
Phone
(240) 223-3533

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X D0065513 MD Primary

Addresses

Primary practice location

1400 Mercantile LN
Suite 110
Largo, MD 20774-5341

Mailing address

PO Box 7224
Largo, MD 20792-7224

National Provider Directory

National Provider Directory

Locations

1400 Mercantile Ln
Ste 110
Upper Marlboro, MD 20774
Phone (240) 223-3533

Practitioners & affiliated clinicians

Practitioners 2

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": "1353283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355961600000",
    "number": "1669716395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7224",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207927224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MERCANTILE LN",
            "address_2": "SUITE 110",
            "city": "LARGO",
            "state": "MD",
            "postal_code": "207745341",
            "telephone_number": "240-223-3533",
            "fax_number": "240-465-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISAGE DERMATOLOGY AND AESTHETIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-19",
        "last_updated": "2012-12-20",
        "status": "A",
        "authorized_official_last_name": "ST. SURIN-LORD",
        "authorized_official_first_name": "SHARLEEN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "240-223-3533",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MD",
            "license": "D0065513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Largo, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.