MEDICARE: MEDICAL AND AESTHETIC DERMATOLOGY

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
1	261Q00000X	Clinic/Center	D72260	MD

General Provider Information

NPI Number	:	1720364227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL AND AESTHETIC DERMATOLOGY

Provider Business Mailing Address
First Line	:	9256 BENDIX RD STE 200A
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9256 BENDIX RD STE 200A
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1848
Country	:	US
Telephone Number	:	302-593-5829
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHERYL BANSAL
Credential	:	MD
Telephone Number	:	302-593-5829

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	06/29/2023

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