NPIMap

Organization Active NPI

Advanced Dermatology of Maryland PC

  • Dermatology Physician
  • Rockville, MD
National Provider Identifier
1760856413
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY OF MARYLAND PC
Practice address
2401 Research Blvd Ste 260
Rockville, MD 20850-3261
Phone
(301) 990-6565
Fax
(301) 990-8525
NPI assigned
Nov 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Authorized official

Name
Matt Louis Leavitt, DO
Title
DO / Owner
Phone
(407) 875-2080

Specialties & licenses 1

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

Addresses

Primary practice location

2401 Research Blvd Ste 260
Rockville, MD 20850-3261

Mailing address

151 Southhall LN
Suite 300
Maitland, FL 32751-7176
Phone (407) 875-2080

Other identifiers 1

IdentifierTypeStateIssuer
8025029MedicaidMD

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20161212000308 MD Part B Supplier - Clinic/Group Practice 9931489804 Receives reassigned benefits from 38 practitioners
2 other NPIs on this enrollment
Practice locations: Towson, MD; Pikesville, MD; La Plata, MD; Cockeysville, MD; Annapolis, MD; Abingdon, MD
O20161216000688 DC Part B Supplier - Clinic/Group Practice 9931489804 Receives reassigned benefits from 29 practitioners
3 other NPIs on this enrollment
Practice locations: Rockville, MD; Oxon Hill, MD; Olney, MD; Ft Washington, MD

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
21D2027263Advanced Dermatology of Maryland2401 Research Blvd Ste 260, Rockville, MD 20850AccreditationJan 25, 2028

National Provider Directory

National Provider Directory

Locations

200 Harry S Truman Pkwy
Ste 400
Annapolis, MD 21401
Phone (410) 897-0272

200 Harry S Truman Pkwy
Ste 270
Annapolis, MD 21401
Phone (410) 897-0272

200 Harry S Truman Pkwy
Ste 440
Annapolis, MD 21401
Phone (410) 266-5790

11701 Livingston Rd
#320
Fort Washington, MD 20744

11701 Livingston Rd
Ste 302
Ft Washington, MD 20744
Phone (301) 292-6010

101 Centennial St
Ste H
La Plata, MD 20646
Phone (301) 292-6010

1838 Greene Tree Rd
Ste 340
Pikesville, MD 21208
Phone (410) 602-3376

2401 Research Blvd
Ste 270
Rockville, MD 20850

45155 Research Pl
Ste 140
Ashburn, VA 20147
Phone (703) 858-0500

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 50

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516579200000",
    "number": "1760856413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "SUITE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517176",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 RESEARCH BLVD STE 260",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208503261",
            "telephone_number": "301-990-6565",
            "fax_number": "301-990-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF MARYLAND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2018-01-22",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "DO / OWNER",
        "authorized_official_telephone_number": "407-875-2080",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8025029",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2018; 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.