SHADY GROVE DERMATOLOGY
NPI 1790177210
Specialist in Rockville, MD
NPI Status: Active since February 20, 2015
Contact Information
15245 SHADY GROVE RD
SUITE 370
ROCKVILLE, MD
ZIP 20850
Phone: (240) 246-7417
- Organization
- Specialist
- CLIA Number: 21D2112261
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-01-2027
About SHADY GROVE DERMATOLOGY
This page provides the complete NPI Profile along with additional information for Shady Grove Dermatology, a provider established in Rockville, Maryland operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1790177210 assigned on February 2015. The practitioner's primary taxonomy code is 174400000X with license number D0028453 (MD). The provider is registered as an organization and their NPI record was last updated 2 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The provider's former legal business name is Shady Grove Dermatology, Llc. The authorized official of this NPI record is Mrs. Sandee Hall Davidson (Business Consultant)
- NPI
- 1790177210
- Provider Legal Name
- SHADY GROVE DERMATOLOGY
- Other Organization Name
- SHADY GROVE DERMATOLOGY, LLC
- Other Name Type
- Former Legal Business Name (4)
- Entity Type
- Organization
- Location Address
- 15245 SHADY GROVE RD SUITE 370 ROCKVILLE, MD 20850
- Location Phone
- (240) 246-7417
- Mailing Address
- 15245 SHADY GROVE RD SUITE 370 ROCKVILLE, MD 20850
- Mailing Phone
- (240) 246-7417
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-20-2015
- Last Update Date
- 03-05-2024
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- D0028453
- License State
- MD
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QM2500X | Ambulatory Health Care Facilities | Clinic/Center |
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 21D2112261
- Facility Type
- Physician Office
- Certificate Effective Date
- December 02, 2025
- Certificate Expiration Date
- December 01, 2027
- Laboratory Director
- JOSEF K. YEAGER
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Shady Grove Dermatology after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1790177210, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
ROCKVILLE, MD 20850
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1790177210, enumerated as an "organization" on February 20, 2015.
The provider is located at 15245 SHADY GROVE RD SUITE 370 ROCKVILLE, MD 20850 and the phone number is (240) 246-7417.
Specialist with taxonomy code 174400000X.
