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General NPI Number Information
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NPI Number | 1538953823
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Entity Type | Organization
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Legal Business Name | EPIPHANY DERMATOLOGY OF MARYLAND PA
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 19735 GERMANTOWN RD STE 210
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City | GERMANTOWN
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State | MD
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Zip | 20874-1217
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Country | US
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Telephone | 301-444-0153
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 RANCH ROAD 2222, BLDG 1, STE 200
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City | AUSTIN
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State | TX
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Zip | 78730
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Country | US
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Telephone | 512-628-0465
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GHEORGHE PUSTA
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Credential |
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Telephone | 512-628-0465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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