Provider Demographics
NPI:1043457468
Name:MID ATLANTIC SKIN SURGERY INSTITUTE
Entity type:Organization
Organization Name:MID ATLANTIC SKIN SURGERY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KANNARKAT
Authorized Official - Last Name:VERGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-396-3401
Mailing Address - Street 1:173 SAINT PATRICKS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5531
Mailing Address - Country:US
Mailing Address - Phone:301-396-3401
Mailing Address - Fax:301-396-3403
Practice Address - Street 1:173 SAINT PATRICKS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5529
Practice Address - Country:US
Practice Address - Phone:301-475-8091
Practice Address - Fax:301-472-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty