VISAGE DERMATOLOGY AND AESTHETIC CENTER, LLC (NPI# 1669716395) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669716395 |
| Entity Type | Organization |
| Organization Name | VISAGE DERMATOLOGY AND AESTHETIC CENTER, LLC |
| Practice Address |
1400 Mercantile Ln Suite 110 Largo MD 20774-5341 |
| Mailing Address |
Po Box 7224 Largo MD 20792-7224 |
| Practice Telephone | 2402233533 |
| Practice Fax Number | 2404654800 |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2012-12-20 |
| Authorized Official Name | DR. SHARLEEN ST. SURIN-LORD (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2402233533 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | D0065513 | MD | Allopathic & Osteopathic Physicians |
| Street Address |
1400 MERCANTILE LN SUITE 110 |
| City | LARGO |
| State | MD |
| Zip Code | 20774-5341 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972596690 | Barbara Christine Williamson | Dermatology | 1400 Mercantile Ln, Ste#110, Largo, MD 20774-5341 | 2005-08-28 |
| 1699229021 | Growth Connections LLC | Social Worker | 1400 Mercantile Ln, Suite 260, Largo, MD 20774-5341 | 2016-08-15 |
| 1164884151 | Shirelle Wright | Social Worker | 1400 Mercantile Ln, Suite 260, Largo, MD 20774-5341 | 2016-03-28 |
| 1003214891 | Livin' The Light, LLC | Case Manager/Care Coordinator | 1400 Mercantile Ln, Suite 208, Largo, MD 20774-5341 | 2014-12-11 |
| 1265709364 | Emery Jefferies | Counselor | 1400 Mercantile Ln, #232, Largo, MD 20774-5341 | 2011-11-17 |
| 1831485911 | Timothy Pass | Clinic/Center | 1400 Mercantile Ln, 232, Largo, MD 20774-5341 | 2011-06-27 |
| 1972897767 | Linda Uwanaka Ebonine | Physician Assistant | 1400 Mercantile Ln, Suite 200, Largo, MD 20774-5341 | 2011-06-08 |
| 1184916975 | Patrice Amos Brown | Occupational Therapist | 1400 Mercantile Ln, 240, Largo, MD 20774-5341 | 2011-05-11 |
| 1467751289 | Yvonne D Loftin-woodard | Social Worker | 1400 Mercantile Ln, 232, Largo, MD 20774-5341 | 2011-03-18 |
| 1972801272 | Marquitta Lynn Duvernay | Counselor | 1400 Mercantile Ln, 232, Largo, MD 20774-5341 | 2011-03-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922637156 | Marie Charlotte Teboutsou Tsodzou | Nurse Practitioner | 9317 Lavall Drive, Upper Marlboro, MD 20774 | 2020-04-08 |
| 1467093443 | Richland Support Services Corp. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11551 Joyceton Drive, Upper Marlboro, MD 20774 | 2019-10-01 |
| 1770134124 | Alan L Kahn | Counselor | 301 Largo Rd., Largo, MD 20774 | 2019-09-26 |
| 1619522034 | Francisca Ifeoma Alintah | Registered Nurse | 511 Dennis Magruder Dr., Upper Marlboro, MD 20774 | 2019-08-02 |
| 1609337146 | Crystal Osuchukwu | Counselor | 1300 Mccormick Dr, Upper Marlboro, MD 20774 | 2019-03-27 |
| 1861968489 | Collaborative Concepts of Maryland | Counselor | 1400 Mercantile Lane, Suite 208, Largo, MD 20774 | 2018-10-22 |
| 1073097622 | Triple Angels Homecare Services, Inc. | In Home Supportive Care | 1210 Dixie Bowie Way, Upper Marlboro, MD 20774 | 2018-09-19 |
| 1922589654 | Optimum Resource Services, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 711 Harry S. Truman Dr, Unit #105, Largo, MD 20774 | 2018-08-21 |
| 1811475254 | Kolawole Richard Olatunde | Home Health Aide | 11405 Villa Court, Upper Marlboro, MD 20774 | 2018-07-28 |
| 1548747769 | Tiara Williams | Counselor | 15207 Harriet Clotilda Way, Upper Marlboro, MD 20774 | 2018-07-20 |
| Find all providers in zip 20774 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457765968 | Summer Moon | Dermatology | 115 Highland Ave N, Largo, FL 33770 | 2014-06-12 |
| 1770726499 | Whitney Lapolla Delozier | Dermatology | 8787 Bryan Dairy Rd Ste 360, Largo, FL 33777-1260 | 2009-04-10 |
| 1912143603 | Preventative Wound Care Associates LLC | Dermatology | 9956 Sago Point Dr, Largo, FL 33777-4913 | 2008-12-30 |
| 1164679668 | Christopher J Ballard | Dermatology | 11200 Seminole Blvd Ste 205, Largo, FL 33778-3240 | 2008-08-26 |
| 1972596690 | Barbara Christine Williamson | Dermatology | 1400 Mercantile Ln, Ste#110, Largo, MD 20774-5341 | 2005-08-28 |
| 1750895140 | Christina Michelle Baden | Dermatology | 8250 Bryan Dairy Rd Ste 250, Largo, FL 33777-1360 | 2017-11-22 |
| 1528416633 | Erin Lowe | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2016-05-31 |
| 1326496522 | Katherine Weber Braunlich | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2016-05-27 |
| 1568807238 | Dawnielle Endly | Dermatology | 201 14th St Sw, Largo, FL 33770-3133 | 2013-05-07 |
| 1841555398 | Carolyn Ellis | Dermatology | 2025 Indian Rocks Rd S, Largo, FL 33774-1035 | 2012-07-11 |
| Find all providers in LARGO | ||||
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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.