Blake R Zelickson, M.D., PH.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101269123 Issued in VA

Practice address

22365 Broderick Drive, Suite 115
Sterling, VA 20166-9362

Phone

(170) 399-6400

Fax

(571) 707-8123

NPI assigned

Apr 13, 2015

Last updated

Jan 5, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clear DermatologyGroup PAC ID 1254850811, 2 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.65 of 100Reported as apm

Quality

85.31

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: blake.zelickson@lmg1.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clear Dermatology

  • Dermatology Physician
  • Sterling, VA
  • NPI 1891509402
  Medicare reassignment Care Compare group NPD
• Integrated Dermatology of Fairfax, LLC

  • Dermatology Physician
  • Fairfax, VA
  • NPI 1861890303
  NPD
• Loudoun Medical Group, PC

  dba Loudoun Medical Group, PC 'D'

  • Vascular Surgery Physician
  • Reston, VA
  • NPI 1588376321
  NPD
• Loudoun Medical Group, PC

  • Internal Medicine Physician
  • Leesburg, VA
  • NPI 1679591440

  Dermatology

  NPD
• Malcolm Ke, M.D., a Professional Corporation

  dba Clear Dermatology

  • Dermatology Physician
  • Torrance, CA
  • NPI 1225350069
  NPD (past)

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

{
    "created_epoch": "1428883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1902292394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22365 BRODERICK DR STE 115",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201669362",
            "telephone_number": "703-996-4000",
            "fax_number": "571-707-8123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22365 BRODERICK DRIVE, SUITE 115",
            "city": "STERLING",
            "state": "VA",
            "postal_code": "201669362",
            "telephone_number": "170-399-6400",
            "fax_number": "571-707-8123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZELICKSON",
        "first_name": "BLAKE",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D., PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-04-13",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101269123",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1902292394",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30017647860001",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dian Yu, M.D.
• Farhad Zangeneh, MD
• Roya Zarnegar, NP
• Jordan Zebert
• Rolando A Zelada I
• Zina Alathari, DMD PC
• Emily Lynn Zorc

• Dermatology Physician in Sterling, VA
• Providers in Sterling, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.