Organization
DERMATOLOGY & ADVANCED SKIN CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELISA RUSONIS (ADMINISTRATOR)
(410) 203-0607
Entity
Organization
Contact information
Practice address
6021 UNIVERSITY BLVD, SUITE 390, ELLICOTT CITY, MD 21043-6077
(410) 203-0607
(410) 203-0677
Mailing address
6021 UNIVERSITY BLVD, SUITE 390, ELLICOTT CITY, MD 21043-6077
(410) 203-0607
(410) 203-0677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0030058
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
553M860F
MEDICARE PTAN
MD
Enumeration date
07/09/2006
Last updated
07/01/2010
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