ADVANCED DERMATOLOGY OF MARYLAND PC
NPI 1386479004
Dermatology in Fort Washington, MD

Active since September 03, 2024CLIA 21D1105196 · Waiver
11701 LIVINGSTON RD STE 302, FORT WASHINGTON, MD 20744(301) 292-6010 Get Directions Write a Review

NPPES record last updated: September 3, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Advanced Dermatology Of Maryland Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ADVANCED DERMATOLOGY OF MARYLAND PC (NPI 1386479004) is a healthcare organization registered as a dermatology in Fort Washington, Maryland and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through July 22, 2028 and lists Matt Louis Leavitt, Owner, as its authorized official.

NPPES Registry Identity

NPI1386479004
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameADVANCED DERMATOLOGY OF MARYLAND PC
Location Address11701 LIVINGSTON RD STE 302Fort Washington, MD 20744-5146
Mailing Address151 Southhall Ln Ste 300Maitland, FL 32751-7172 · (407) 875-2080
Organization SubpartYes
Authorized OfficialMatt Louis LeavittOwner · (407) 875-2080
Enumeration DateSeptember 3, 2024
NPPES CertifiedSeptember 3, 2024
✔ NPI 1386479004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
11701 LIVINGSTON RD STE 302, Fort Washington, MD 20744

Other Identifiers 1

Medicaid8025029MD

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Advanced Dermatology Of Maryland Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

14

Medicare enrollment records show 14 clinicians reassign Medicare billing to Advanced Dermatology Of Maryland PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 5

Dermatology10
Diagnostic Radiology1
Micrographic Dermatologic Surgery (MDS)1
Nurse Practitioner1
Pathology1

Clinicians, nearest first (14)

Dermatology
NPI 1861561730
11701 LIVINGSTON RD 302
Fort Washington, MD 20744
(301) 292-6010
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1710056692
11701 LIVINGSTON RD 302
Fort Washington, MD 20744
(301) 292-6010
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1477820769
1500 GALEN ST SE
Washington, DC 20020
(202) 610-7160
✔ PECOS✔ Accepts Medicare9.3 mi
Dermatology
NPI 1730151119
4660 KENMORE AVE SUITE 500
Alexandria, VA 22304
(703) 370-0073
✔ PECOS✔ Accepts Medicare9.3 mi
Dermatology
NPI 1063807980
4660 KENMORE AVE STE 1100
Alexandria, VA 22304
(703) 370-0073
✔ PECOS✔ Accepts Medicare9.3 mi
Dermatology
NPI 1023288156
1400 MERCANTILE LN SUITE 110
Largo, MD 20774
(301) 773-7546
✔ PECOS✔ Accepts Medicare15 mi
Micrographic Dermatologic Surgery (MDS)
NPI 1134252455
10680 MAIN ST STE 200
Fairfax, VA 22030
(703) 352-2620
✔ PECOS✔ Accepts Medicare19 mi
Dermatology
NPI 1932295508
4000 MITCHELLVILLE RD #206
Bowie, MD 20716
(301) 262-7550
✔ PECOS✔ Accepts Medicare21 mi
Dermatology
NPI 1306826102
2401 RESEARCH BLVD
Rockville, MD 20850
(301) 990-6565
✔ PECOS✔ Accepts Medicare28 mi
Dermatology
NPI 1396724779
2401 RESEARCH BLVD SUITE 260
Rockville, MD 20850
(301) 990-6565
✔ PECOS✔ Accepts Medicare28 mi
Dermatology
NPI 1922685502
200 HARRY S TRUMAN PKWY STE 400
Annapolis, MD 21401
(410) 897-0272
✔ PECOS✔ Accepts Medicare30 mi
Pathology
NPI 1598297962
231 NAJOLES RD STE 460
Millersville, MD 21108
(443) 883-8563
✔ PECOS✔ Accepts Medicare32 mi
Diagnostic Radiology
NPI 1932119690
45155 RESEARCH PL SUITE 140
Ashburn, VA 20147
(703) 858-0500
✔ PECOS✔ Accepts Medicare33 mi
Dermatology
NPI 1366407157
45155 RESEARCH PL SUITE 140
Ashburn, VA 20147
(703) 858-0500
✔ PECOS✔ Accepts Medicare33 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D1105196

Advanced Dermatology Of Maryland · Fort Washington, MD
Active · expires Jul 22, 2028
CLIA Number21D1105196
Laboratory TypePhysician Office
Certificate Effective DateJuly 23, 2026
Certificate Expiration DateJuly 22, 2028
Laboratory DirectorDr. Sharleen St Surin-Lord
Laboratory Phone(407) 284-3407
Laboratory LocationAdvanced Dermatology Of Maryland11701 Livingston Road Ste 302, Fort Washington, MD 20744
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Advanced Dermatology Of Maryland PC's NPI number?

The NPI number for Advanced Dermatology Of Maryland PC is 1386479004. It was assigned to this organization in the NPPES registry on September 3, 2024.

Where is Advanced Dermatology Of Maryland PC located?

Advanced Dermatology Of Maryland PC is located at 11701 Livingston Rd Ste 302, Fort Washington, MD 20744. The listed phone number is (301) 292-6010.

What is Advanced Dermatology Of Maryland PC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Advanced Dermatology Of Maryland PC enrolled in Medicare?

Yes. Advanced Dermatology Of Maryland PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Advanced Dermatology Of Maryland PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 14 clinicians in 5 Medicare specialties reassign their Medicare billing to Advanced Dermatology Of Maryland PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (10), Diagnostic Radiology (1) and Micrographic Dermatologic Surgery (MDS) (1). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Advanced Dermatology Of Maryland PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D1105196) is associated with this NPI, valid through July 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Advanced Dermatology Of Maryland PC was last updated on September 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.