CLARKSBURG DERMATOLOGY AND SKINCARE LLC (NPI# 1316439078) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316439078 |
| Entity Type | Organization |
| Organization Name | CLARKSBURG DERMATOLOGY AND SKINCARE LLC |
| Practice Address |
23202 Brewers Tavern Way Clarksburg MD 20871 |
| Mailing Address |
1136 Opal Ct Hagerstown MD 21740-5940 |
| Practice Telephone | 3012981818 |
| Practice Fax Number | 3015401865 |
| Mailing Telephone | 8004306311 |
| Mailing Fax Number | 2404694836 |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-07-12 |
| Authorized Official Name | JOHANNA FANGMEYER (OWNER) |
| Authorized Official Telephone | 3012981818 |
| Authorized Official Credential | CRNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | R134352 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
23202 BREWERS TAVERN WAY |
| City | CLARKSBURG |
| State | MD |
| Zip Code | 20871 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124263066 | Prestige Physical Therapy LLC | Specialist | 23202 Brewers Tavern Way, Clarksburg, MD 20871-4391 | 2008-12-05 |
| 1912345471 | Clarksburg Eye Care, LLC | Optometrist | 23202 Brewers Tavern Way, Clarksburg, MD 20871-4391 | 2013-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366097578 | Shelah Maul | Speech-Language Pathologist | Clarksburg Elementary School, 13530 Redgrave Place, Clarksburg, MD 20871 | 2019-08-05 |
| 1013401769 | Thin Phyu Bur | Social Worker | 13446 Dutrow Dr, Clarksburg, MD 20871 | 2018-06-17 |
| 1750754925 | Milankumar Maheshbhai Patel | Physical Therapist | 23923 Basil Park Circle, Clarksburg, MD 20871 | 2015-11-09 |
| 1093142796 | Harris Teeter, LLC | Durable Medical Equipment & Medical Supplies | 22700 Sweet Shrub Drive, Clarksburg, MD 20871 | 2013-09-26 |
| 1932493046 | Chidinma Ebele | Case Management | 23447 Tailor Shop Pl, Clarksburg, MD 20871 | 2011-06-06 |
| 1396036455 | Reliance Home Care | Home Health | 12615 Blue Sky Drive, Clarksburg, MD 20871 | 2011-04-25 |
| 1063721629 | Clarksburg Medical Center Inc | Ophthalmology | 22616 Gateway Center Dr Ste 600a, Clarksburg, MD 20871 | 2010-09-30 |
| 1548440787 | Patricia J. Tucker | Social Worker | 21925 Frederick Rd, Clarksburg, MD 20871 | 2007-11-05 |
| 1487954509 | Sean Park | Pharmacist | 7025 Brookville Rd, Chevy Chase, MD 20871 | 2010-10-22 |
| 1528331881 | Bio Reference Laboratories, Inc | Clinical Medical Laboratory | 22520 Gateway Center Dr, Ste 400, Clarksburg, MD 20871-2005 | 2012-02-17 |
| Find all providers in zip 20871 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538382130 | Heidi Jo Seti | Nurse Practitioner | 1 Medical Center Drive, Clarksburg, WV 26301 | 2007-04-11 |
| 1316987001 | David P. Peasak II | Nurse Practitioner | 6 Hospital Plz, Clarksburg, WV 26301-9316 | 2006-06-08 |
| 1093791840 | Antoinette R Marascio | Nurse Practitioner | 4 Hospital Plz, Clarksburg, WV 26301-9327 | 2005-12-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961250 | Cassandra Jordan Holmes | Nurse Practitioner | 10 Center Drive Lcim Niaid Nih, Bethesda, MD 20892-0001 | 2020-10-30 |
| 1962000679 | Laly Sorto | Nurse Practitioner | 923 S Curley St, Baltimore, MD 21224-4825 | 2020-10-14 |
| 1841897139 | Ha Le | Nurse Practitioner | 160 Ritchie Hwy, Severna Park, MD 21146-1120 | 2020-10-08 |
| 1386241685 | Audrey Roxanne Mathew | Nurse Practitioner | 546 N Frederick Ave # 1490, Gaithersburg, MD 20877-2504 | 2020-10-08 |
| 1093312209 | Shelby Bruno | Nurse Practitioner | 29 S Greene St Fl 2, Baltimore, MD 21201-1504 | 2020-10-01 |
| 1295342772 | Gilead Associates LLC | Nurse Practitioner | 206 Mulberry Ridge Ct, Pasadena, MD 21122-7514 | 2020-09-28 |
| 1659986735 | Tatyana Vladimirovna Valentin | Nurse Practitioner | 490 Cadmus Ln Ste 102, Easton, MD 21601-4091 | 2020-09-15 |
| 1205440328 | Courtney Lavon Phillip | Nurse Practitioner | 4461 Pleasant Hill Ct, Pomfret, MD 20675-3104 | 2020-09-04 |
| 1386256634 | Steven Carroll | Nurse Practitioner | 731 Crisfield Way, Annapolis, MD 21401-4576 | 2020-08-18 |
| 1346850666 | Cynthia Adwoah Mireku-baabu | Nurse Practitioner | 19241 Sharon Dr, Hagerstown, MD 21742-2433 | 2020-08-01 |
| Find all providers with the same taxonomy | ||||
| City | CLARKSBURG |
| Zip Code | 20871 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.