MEDICARE: SOUTHERN MARYLAND SKIN SPECIALISTS, PC

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
1	207N00000X	Dermatology Physician	D00037292	MD

General Provider Information

NPI Number	:	1558497362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN MARYLAND SKIN SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	55 STOAKLEY RD STE F
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3859
Country	:	US
Telephone Number	:	410-535-5855
Fax Number	:	410-535-6574

Provider Business Practice Location Address
First Line	:	55 STOAKLEY RD STE F
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3859
Country	:	US
Telephone Number	:	410-535-5855
Fax Number	:	410-535-6574

Authorized Official
Title or Position	:	PRESIDENT
Name	:	A. FRANK TRIANA
Credential	:	MD
Telephone Number	:	410-535-5855

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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