| Dockside Dermatology LLC | |
|
8601 Veterans Hwy Ste 201 Millersville MD 21108-1566 | |
| (410) 934-5400 | |
| (410) 934-0141 |
| Full Name | Dockside Dermatology LLC |
|---|---|
| Speciality | Dermatology |
| Location | 8601 Veterans Hwy Ste 201, Millersville, Maryland |
| Authorized Official Name and Position | Lesley Sutherland (OWNER) |
| Authorized Official Contact | 4105334200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dockside Dermatology LLC 8601 Veterans Hwy Ste 201 Millersville MD 21108-1566 Ph: (410) 934-5400 | Dockside Dermatology LLC 8601 Veterans Hwy Ste 201 Millersville MD 21108-1566 Ph: (410) 934-5400 |
| NPI Number | 1194479972 |
|---|---|
| Provider Enumeration Date | 02/09/2022 |
| Last Update Date | 03/26/2023 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 9931576733 |
|---|---|
| Medicare Enrollment ID | O20221108002210 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194479972 | NPI | - | NPPES |
| Provider Name | Lesley a Sutherland |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1275953309 PECOS PAC ID: 8527282839 Enrollment ID: I20180427001723 |
| Provider Name | Stephanie Clements |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1295198646 PECOS PAC ID: 3375818149 Enrollment ID: I20200812002983 |
| Provider Name | Alexandra Napoli Crosswhite |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164949053 PECOS PAC ID: 7012282361 Enrollment ID: I20210329001749 |
| Provider Name | Natalia Fontecilla Biles |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1588169395 PECOS PAC ID: 6002297405 Enrollment ID: I20220716000382 |
| Provider Name | Rachel Grabill |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1104450188 PECOS PAC ID: 1052711439 Enrollment ID: I20240423000737 |
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