Provider Demographics
NPI:1174736516
Name:GREATER WASHINGTON DERMATOLOGY PA
Entity type:Organization
Organization Name:GREATER WASHINGTON DERMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-990-6565
Mailing Address - Street 1:2401 RESEARCH BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3261
Mailing Address - Country:US
Mailing Address - Phone:301-990-6565
Mailing Address - Fax:301-990-8525
Practice Address - Street 1:2401 RESEARCH BLVD STE 260
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3261
Practice Address - Country:US
Practice Address - Phone:301-990-6565
Practice Address - Fax:301-990-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043966174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD171451100Medicaid
DC873857Medicare PIN
MD171451100Medicaid