NPIMap

Organization Active NPI

Advanced Dermatology of Maryland PC

  • Dermatology Physician
  • National Harbor, MD
National Provider Identifier
1881429504
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ADVANCED DERMATOLOGY OF MARYLAND PC
Practice address
174 Waterfront Street
Suite 200
National Harbor, MD 20745-1164
Phone
(240) 766-8116
NPI assigned
Sep 3, 2024
Last updated
Sep 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ADVANCED DERMATOLOGY OF MARYLAND PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

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

Authorized official

Name
Matt Louis Leavitt, DONPI 1821108341
Title
Owner
Phone
(407) 875-2080

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X

Addresses

Primary practice location

174 Waterfront Street
Suite 200
National Harbor, MD 20745-1164

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (407) 875-2080

Other identifiers 1

IdentifierTypeStateIssuer
8025029MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161216000688 DC Part B Supplier - Clinic/Group Practice 9931489804 Receives reassigned benefits from 29 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rockville, MD; Oxon Hill, MD; Olney, MD; Ft Washington, MD

Other NPIs on the same Medicare enrollment 3

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
21D2132684Advanced Dermatology of Maryland174 Waterfront Street Suite 200, Oxon Hill, MD 20745Provider-performed microscopyJan 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Advanced Dermatology of MD3 organizations share this tax ID, including this one
Part of
Advanced Dermatology of MD

Other organizations with this tax ID 2

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

Locations

2401 Research Blvd
Ste 260
Rockville, MD 20850
Phone (301) 990-6565

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1725321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1881429504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "407-875-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "174 WATERFRONT STREET",
            "address_2": "SUITE 200",
            "city": "NATIONAL HARBOR",
            "state": "MD",
            "postal_code": "207451164",
            "telephone_number": "240-766-8116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DERMATOLOGY OF MARYLAND PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVANCED DERMATOLOGY OF MARYLAND PC",
        "enumeration_date": "2024-09-03",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "MATT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-875-2080",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8025029",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in National Harbor, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; 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.