NPIMap

Organization Active NPI

Epiphany Dermatology of Maryland PA

Doing business as Epiphany Dermatology

  • Dermatology Physician
  • Bethesda, MD
National Provider Identifier
1679521165
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
EPIPHANY DERMATOLOGY OF MARYLAND PA
Doing business as
Epiphany Dermatology
Practice address
6500 Rock Spring Dr Ste 105
Bethesda, MD 20817-1154
Phone
(301) 530-8300
NPI assigned
May 5, 2006
Last updated
Nov 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

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

Authorized official

Name
Gheorghe Pusta
Title
Executive Director
Phone
(512) 628-0465

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Procedural Dermatology Physician 207NS0135X NU
Plastic Surgery Physician 208200000X NU

Addresses

Primary practice location

6500 Rock Spring Dr Ste 105
Bethesda, MD 20817-1154

Mailing address

7300 Ranch Road 2222, BLDG 1, Ste 200
Austin, TX 78730-3255
Phone (512) 628-0465

Other names 1

  • Epiphany Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040512000344 DC Part B Supplier - Clinic/Group Practice 8426047770 Receives reassigned benefits from 10 practitioners
Practice locations: Bethesda, MD; Germantown, MD
O20250515001269 MD Part B Supplier - Clinic/Group Practice 8426047770 Receives reassigned benefits from 7 practitioners
Practice locations: Towson, 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
21D0211849Epiphany Dermatology of Maryland PA6500 Rock Spring Dr Ste 105, Bethesda, MD 20817ComplianceDec 10, 2026

National Provider Directory

National Provider Directory

Locations

5215 Loughboro Rd NW
Ste 140
Washington, DC 20016
Phone (202) 244-4550

20528 Boland Farm Rd
Ste 103
Germantown, MD 20876
Phone (301) 444-0153

4 Glyndon Dr
Ste 2G
Reisterstown, MD 21136
Phone (410) 526-1300

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762905600000",
    "number": "1679521165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 RANCH ROAD 2222, BLDG 1, STE 200",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787303255",
            "telephone_number": "512-628-0465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 ROCK SPRING DR STE 105",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208171154",
            "telephone_number": "301-530-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY DERMATOLOGY OF MARYLAND PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A",
        "authorized_official_last_name": "PUSTA",
        "authorized_official_first_name": "GHEORGHE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "512-628-0465"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Epiphany Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2025; 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.