1982509519 NPI number — MEDICAL AND AESTHETIC DERMATOLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982509519 NPI number — MEDICAL AND AESTHETIC DERMATOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL AND AESTHETIC DERMATOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982509519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9256 BENDIX RD STE 200A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21045-1848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-542-0505
Provider Business Mailing Address Fax Number:
443-542-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3416 OLANDWOOD CT STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-542-0505
Provider Business Practice Location Address Fax Number:
443-542-0506
Provider Enumeration Date:
10/13/2026

Additional Information

Authorized Official

Authorized Official Last Name:
BANSAL
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
DEWAN
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
443-542-0505

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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