Provider Demographics
NPI:1144183690
Name:MARYLAND SKIN CARE CENTERS LLC
Entity type:Organization
Organization Name:MARYLAND SKIN CARE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMEBER
Authorized Official - Prefix:
Authorized Official - First Name:JAGADEESH
Authorized Official - Middle Name:S V
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-485-6615
Mailing Address - Street 1:216 E PULASKI HWY STE 125
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6498
Mailing Address - Country:US
Mailing Address - Phone:443-485-6614
Mailing Address - Fax:410-286-1700
Practice Address - Street 1:216 E PULASKI HWY STE 125
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6498
Practice Address - Country:US
Practice Address - Phone:443-485-6614
Practice Address - Fax:410-286-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-03
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty