NPIMap

Organization Active NPI

Medical and Aesthetic Dermatology

  • Clinic/Center
  • Columbia, MD
National Provider Identifier
1720364227
Registry record updated Jun 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
D72260 Issued in MD
Legal business name
MEDICAL AND AESTHETIC DERMATOLOGY
Practice address
9256 Bendix Rd Ste 200a
Columbia, MD 21045-1848
Phone
(302) 593-5829
NPI assigned
Oct 27, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2023

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

Authorized official

Name
Dr. Cheryl Bansal, MDNPI 1174790851
Title
Owner
Phone
(302) 593-5829

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
Clinic/Center 261Q00000X D72260 MD Primary

Addresses

Primary practice location

9256 Bendix Rd Ste 200a
Columbia, MD 21045-1848

Mailing address

9256 Bendix Rd Ste 200a
Columbia, MD 21045-1848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111102000847 MD Part B Supplier - Clinic/Group Practice 7810160058 Receives reassigned benefits from 6 practitioners
Practice locations: Columbia, MD
O20260331000880 DC Part B Supplier - Clinic/Group Practice 7810160058 Receives reassigned benefits from 1 practitioner
Practice locations: Olney, MD

National Provider Directory

National Provider Directory

Locations

9256 Bendix Rd
Ste 200A
Columbia, MD 21045
Phone (443) 201-1603

8850 Columbia 100 Pkwy
Ste 316
Columbia, MD 21045
Phone (410) 884-1234

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFJEBA

Practitioners & affiliated clinicians

Practitioners 9

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": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687996800000",
    "number": "1720364227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9256 BENDIX RD STE 200A",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9256 BENDIX RD STE 200A",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210451848",
            "telephone_number": "302-593-5829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL AND AESTHETIC DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-27",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "302-593-5829",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MD",
            "license": "D72260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; 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.