Clinical Dermatology Center, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

CLINICAL DERMATOLOGY CENTER, LLC

Practice address

14500 Avion Pkwy Ste 100
Chantilly, VA 20151-1108

Phone

(703) 705-7000

Fax

(703) 763-7255

NPI assigned

May 14, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Mikhail A Pavlov

Title

Practice Manager

Phone

(410) 371-6302

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

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

• Christian Richard Millett, M.D.

  • Dermatology Physician
  • Arlington, VA
  • NPI 1902138761

  DC

  Medicare reassignment Care Compare group NPD
• Crystal Nwannunu, MD

  • Dermatology Physician
  • Aldie, VA
  • NPI 1669092045

  DC

  Medicare reassignment Care Compare group NPD
• Nickolai Talanin, MD

  • Specialist
  • Chantilly, VA
  • NPI 1578682894

  DC

  Medicare reassignment Care Compare group NPD
• Ilene B Bayer-Garner, MD

  • Dermatopathology Physician
  • Severna Park, MD
  • NPI 1003895764

  DC, Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Monee Marie Thomas, M.D.

  • Dermatology Physician
  • Bellaire, TX
  • NPI 1780021691

  DC

  Medicare reassignment Care Compare group NPD
• Alexandra M Lepecha

  • Physician Assistant
  • Ashburn, VA
  • NPI 1902514235

  DC

  Medicare reassignment Care Compare group
• Kishore Linga Jayakumar

  • Dermatology Physician
  • Upland, PA
  • NPI 1104321942

  DC

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594944000000",
    "number": "1902428709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14500 AVION PKWY STE 100",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511108",
            "telephone_number": "703-705-7000",
            "fax_number": "703-763-7255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14500 AVION PKWY STE 100",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511108",
            "telephone_number": "703-705-7000",
            "fax_number": "703-763-7255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL DERMATOLOGY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A",
        "authorized_official_last_name": "PAVLOV",
        "authorized_official_first_name": "MIKHAIL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "410-371-6302",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1578682894",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phuong-Anh Thi Chung, PA
• Alexa Cisneros
• Claudio Urquiaga DDS PLLC
• Clearaxisrcm LLC
• Ariane C Cleveland, PT, DPT
• Miranda Cobbs
• Comfort Care Home Health, LLC
• Commonwealth Anesthesia Group LLC
• Commonwealth Gastroenterology, PLC
• Community Residences, Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2020; 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.