Healthcare Provider Details

I. General information

NPI: 1902327950
Provider Name (Legal Business Name): INTEGRATED DERMATOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 MCGAW RD STE 150-170
COLUMBIA MD
21045-4743
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 410-203-0607
  • Fax: 410-203-0677
Mailing address:
  • Phone: 561-314-2000
  • Fax: 561-431-2821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: ADAM S. PLOTKIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 561-314-2000