Healthcare Provider Details

I. General information

NPI: 1699234583
Provider Name (Legal Business Name): DYLAN MALDONADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 HARRODSBURG RD STE 2
LEXINGTON KY
40504-3516
US

IV. Provider business mailing address

2195 HARRODSBURG RD STE 2
LEXINGTON KY
40504-3516
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3376
  • Fax: 859-323-0350
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number33819
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number33819
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberTP695
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: