NPIMap

Organization Active NPI

University of Maryland Dermatologists PA

  • Dermatology Physician
  • Ellicott City, MD
National Provider Identifier
1861368946
Registry record updated Oct 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Practice address
6021 University Blvd Ste 370-390
Ellicott City, MD 21043-6077
Phone
(667) 214-1171
NPI assigned
Oct 15, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2025

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

Authorized official

Name
Katelyn Pettit
Title
Reimbursement Ops Credentialing Spe
Phone
(667) 214-1353

Specialties & licenses 1

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

Addresses

Primary practice location

6021 University Blvd Ste 370-390
Ellicott City, MD 21043-6077

Mailing address

PO Box 64445
Baltimore, MD 21264-4445
Phone (410) 328-5767

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040323000770 MD Part B Supplier - Clinic/Group Practice 7810888484 Receives reassigned benefits from 21 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baltimore, MD; Lutherville, MD; Ellicott City, MD; Chestertown, MD; Columbia, MD

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
University of Maryland Dermatologists PA8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6021 University Blvd
Ste 390
Ellicott City, MD 21043
Phone (410) 203-0607

6021 University Blvd
Ste 370390
Ellicott City, MD 21043
Phone (667) 214-1171

NPI Registry JSON

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

{
    "created_epoch": "1760486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1861368946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64445",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212644445",
            "telephone_number": "410-328-5767",
            "fax_number": "410-328-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6021 UNIVERSITY BLVD STE 370-390",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210436077",
            "telephone_number": "667-214-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF MARYLAND DERMATOLOGISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-15",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "KATELYN",
        "authorized_official_title_or_position": "REIMBURSEMENT OPS CREDENTIALING SPE",
        "authorized_official_telephone_number": "667-214-1353"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; 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.