MEDICARE: ANNE ARUNDEL DERMATOLOGY, PA

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

General Provider Information

NPI Number	:	1568292282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE ARUNDEL DERMATOLOGY, PA

Provider Business Mailing Address
First Line	:	PO BOX 23329
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3329
Country	:	US
Telephone Number	:	410-873-8500
Fax Number	:	404-301-9057

Provider Business Practice Location Address
First Line	:	995 PRINCE FREDERICK BLVD STE 204&205
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3198
Country	:	US
Telephone Number	:	443-351-3376
Fax Number	:	410-535-6574

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	LAURA J HERNANDEZ
Credential	:
Telephone Number	:	813-493-5252

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	01/12/2026

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