Organization
ADVANCED DERMATOLOGY OF MARYLAND PC
Active
Parent organization
ADVANCED DERMATOLOGY OF MARYLAND PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED DERMATOLOGY OF MARYLAND PC
Authorized official
MATT LOUIS LEAVITT DO (OWNER)
(407) 875-2080
Entity
Organization
Contact information
Practice address
101 CENTENNIAL ST STE H, LA PLATA, MD 20646-5976
(301) 292-6010
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(407) 875-2080
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8025029
—
MD
Enumeration date
09/03/2024
Last updated
09/03/2024
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