NPIMap

Individual provider Active NPI

Pavan Kumar Nootheti, M.D., FAAD

  • MOHS-Micrographic Surgery Physician
  • College Park, MD
National Provider Identifier
1912130287
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
D73150 Issued in MD
Practice address
4700 Berwyn House Rd
Suite 108
College Park, MD 20740-2474
Phone
(858) 752-4459
NPI assigned
Sep 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A90335 CA
MOHS-Micrographic Surgery Physician 207ND0101X A90335 CA
MOHS-Micrographic Surgery Physician 207ND0101X D73150 MD Primary
Dermatology Physician 207N00000X D73150 MD
Dermatology Physician 207N00000X MD33040 DC
MOHS-Micrographic Surgery Physician 207ND0101X MD33040 DC

Addresses

Primary practice location

4700 Berwyn House Rd
Suite 108
College Park, MD 20740-2474

Mailing address

1 Stapleford Hall CT
Potomac, MD 20854-4451
Phone (858) 752-4459

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Anne Arundel Dermatology, PA Dermatology CurrentSince Aug 11, 2024 Accepting new patients
Arch Health Partners PastSince Feb 10, 2011 Accepting new patients
Arch Health Partners PastSince Feb 10, 2011 Accepting new patients
Arch Health Partners PastSince Feb 10, 2011 Accepting new patients
Arch Health Partners, Inc PastSince Feb 10, 2011 Accepting new patients
Arch Health Partners PastSince Feb 10, 2011 Accepting new patients

Locations

1306 Concourse Dr
Ste 201
Linthicum Heights, MD 21090

995 Prince Frederick Blvd
Ste 204
Prince Frederick, MD 20678
Phone (410) 535-5855

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1251849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325721600000",
    "number": "1912130287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 STAPLEFORD HALL CT",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208544451",
            "telephone_number": "858-752-4459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 BERWYN HOUSE RD",
            "address_2": "SUITE 108",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207402474",
            "telephone_number": "858-752-4459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NOOTHETI",
        "first_name": "PAVAN",
        "middle_name": "KUMAR",
        "credential": "M.D., FAAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-02",
        "last_updated": "2012-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A90335",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A90335",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "MD",
            "license": "D73150",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MD",
            "license": "D73150",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "DC",
            "license": "MD33040",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "DC",
            "license": "MD33040",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in College Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.