Aesthetic Dermatology and Dermatologic Surgery Center
NPI 1104068790ActiveOrganization· Specialist· Bowie, MD
Specialist in Bowie, Maryland, registered in NPPES in March 2009. The authorized official on file is Debra A. Coats-Walton, MD, Medical Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1104068790 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Mar 30, 2009 |
| Last updated in NPPES | Aug 27, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | D0051777 | MD |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (DC) |
|---|
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