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NPI Code Detail

MEDICARE: PROFESSIONAL DERMATOLOGY CARE, PC

MEDICARE: PROFESSIONAL DERMATOLOGY CARE, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist0101232644VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11558319319OTHERVAINDIVIDUAL NPI NUMBER FOR MAITHILY A. NANDEDKAR

General Provider Information

NPI Number : 1598776817
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL DERMATOLOGY CARE, PC
Provider Business Mailing Address
First Line : 1801 ROBERT FULTON DR
Second Line : SUITE 520
City : RESTON
State : VA
Zip : 20191-5461
Country : US
Telephone Number : 703-860-1818
Fax Number : 703-860-5303
Provider Business Practice Location Address
First Line : 1801 ROBERT FULTON DR
Second Line : SUITE 520
City : RESTON
State : VA
Zip : 20191-5461
Country : US
Telephone Number : 703-860-1818
Fax Number : 703-860-5303
Authorized Official
Title or Position : OWNER
Name : DR. MAITHILY NANDEDKAR
Credential : M.D.
Telephone Number : 703-860-1818
Provider Enumeration Date : 08/11/2006
Last Update Date : 01/03/2012

Similar Medicare Providers

1265182794 — EVBU SHARON OSAKUE DDS
Practice Location Address:
1801 ROBERT FULTON DR
RESTON, VA
20191-5461
Practice Phone: 703-495-3333
Practice Fax:
1578568788 — MS. MARGARET RIGGAN LIGHT NURSE PRACTITIONER
Practice Location Address:
1801 ROBERT FULTON DR , STE 140
RESTON, VA
20191-5461
Practice Phone: 703-876-9300
Practice Fax: 703-876-9811
1558319319 — DR. MAITHILY A. NANDEDKAR M.D
Practice Location Address:
1801 ROBERT FULTON DR , SUITE 520
RESTON, VA
20191-5461
Practice Phone: 703-860-1818
Practice Fax: 703-860-5303
1770666000 — DR. DARREN CHRISTOPHER BRENNAN PSYD
Practice Location Address:
1801 ROBERT FULTON DR STE 230
RESTON, VA
20191-5461
Practice Phone: 703-391-9410
Practice Fax: 703-476-7634
1588783476 — DR. DIMA ALI M.D.
Practice Location Address:
1801 ROBERT FULTON DR , SUITE 540
RESTON, VA
20191-5461
Practice Phone: 703-787-9866
Practice Fax:
1679867212 — DR. RACHEL LYNN PIECHOWIAK D.O.
Practice Location Address:
1801 ROBERT FULTON DRIVE, SUITE 510
RESTON, VA
20191-5461
Practice Phone: 703-783-5355
Practice Fax: 703-348-6376

Directions to “PROFESSIONAL DERMATOLOGY CARE, PC ” Practice Location

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