DR. BLAKE R ZELICKSON (M.D., PH.D.) – Dermatology Physician, NPI 1902292394

DR. BLAKE R ZELICKSON (M.D., PH.D.) is a healthcare provider. based in Leesburg, Virginia. specializing in DERMATOLOGY. They hold the professional credentials M.D., PH.D.. They hold a License No. 0101269123 (VA). The NPI Number for DR. BLAKE R ZELICKSON (M.D., PH.D.) is 1902292394

Main info

Male
Sole Proprietor
11 Years Of Experience
Accepts Medicare Assignment
Name
DR. BLAKE R ZELICKSON (M.D., PH.D.)
NPI
1902292394
Phone
(703) 737-6001
Address
224D CORNWALL ST NW STE 403
Enumeration Date
13 April 2015
Last Update Date
5 January 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7039964000
Graduation Year
2015 (11 years ago)
PAC ID
9032532213
Group Practice PAC ID
1254850811
Professional Enrollment ID
I20200707000356
Address ID
VA201669362ST22365DRXX301
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience46
Completeness85
Years active:11State licenses:1Digital endpointsOther names

471 DERMATOLOGY in VA

Provider Addresses for DR. BLAKE R ZELICKSON (M.D., PH.D.)

  • 224D CORNWALL ST NW STE 403

    LEESBURG, VA 201762704

    Phone: (703) 737-6001

    Fax: (901) 448-1299

    Type: Mailing

  • 22365 BRODERICK DR STE 115

    STERLING, VA 201669362

    Phone: (703) 996-4000

    Fax: (571) 707-8123

    Type: Mailing

  • 22365 BRODERICK DRIVE, SUITE 115

    STERLING, VA 201669362

    Phone: (170) 399-6400

    Fax: (571) 707-8123

    Type: Location

  • 21785 FILIGREE CT STE 206

    ASHBURN, VA 201476214

    Phone: (703) 996-4000

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 42 Open Payments records for all available years, with a total value of $1,553.

Total Amount is formed as General ($1,553) + Research ($0) + Ownership ($0) = $1,553.

Last reported payment date: 2024-12-18 • Largest payer in this snapshot: ABBVIE INC. ($277).

Total Amount

$1,553

General + Research + Ownership

Payments

42

Total payment records

General Amount

$1,553

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-07-07

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200707000356IDermatologyVATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes152131$0
17003Destruction of precancer skin growth, 2-14 growths15228$0
11102Biopsy of related skin growth, first growth11494$0
99214Established patient office or other outpatient visit, 30-39 minutes8160$0
J3301Injection, triamcinolone acetonide, not otherwise specified, 10 mg8011$0
View full utilization report →

Insurance plans in this area (ZIP 20176)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1254850811View full group profile
NameSpecialtyState
D E R M A T O L O G YVA

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Frequently asked questions

How is DR. BLAKE R ZELICKSON (M.D., PH.D.) identified in CMS data?
CMS-hosted NPPES data lists DR. BLAKE R ZELICKSON (M.D., PH.D.) with NPI 1902292394.
Does the file indicate DR. BLAKE R ZELICKSON (M.D., PH.D.) is practicing under active NPI?
Directory data currently reports DR. BLAKE R ZELICKSON (M.D., PH.D.) as active.
What taxonomy line describes DR. BLAKE R ZELICKSON (M.D., PH.D.)?
For research purposes, treat DR. BLAKE R ZELICKSON (M.D., PH.D.) as Dermatology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Does DR. BLAKE R ZELICKSON (M.D., PH.D.) list a practice location?
Patients near Leesburg, Virginia may find DR. BLAKE R ZELICKSON (M.D., PH.D.) in results; validate coverage separately.
Why does DR. BLAKE R ZELICKSON (M.D., PH.D.) have multiple addresses?
4 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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