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NPI Code Detail

MEDICARE: ACADEMIC ALLIANCE IN DERMATOLOGY, INC

MEDICARE: ACADEMIC ALLIANCE IN DERMATOLOGY, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538119722
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACADEMIC ALLIANCE IN DERMATOLOGY, INC
Provider Business Mailing Address
First Line : 1306 CONCOURSE DR STE 201
Second Line :
City : LINTHICUM HEIGHTS
State : MD
Zip : 21090-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5210 WEBB RD
Second Line :
City : TAMPA
State : FL
Zip : 33615-4518
Country : US
Telephone Number : 813-882-9986
Fax Number : 813-882-9849
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : ANGELA RUTH PETERMAN
Credential : MD
Telephone Number : 410-766-0111
Provider Enumeration Date : 05/11/2006
Last Update Date : 12/31/2024

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Directions to “ACADEMIC ALLIANCE IN DERMATOLOGY, INC ” Practice Location

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