Healthcare Provider Details

I. General information

NPI: 1679521165
Provider Name (Legal Business Name): EPIPHANY DERMATOLOGY OF MARYLAND PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 ROCK SPRING DR STE 105
BETHESDA MD
20817-1154
US

IV. Provider business mailing address

7300 RANCH ROAD 2222, BLDG 1, STE 200
AUSTIN TX
78730-3255
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-8300
  • Fax:
Mailing address:
  • Phone: 512-628-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GHEORGHE PUSTA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 512-628-0465