Healthcare Provider Details

I. General information

NPI: 1063481703
Provider Name (Legal Business Name): ANNE ARUNDEL DERMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY STE 630
ANNAPOLIS MD
21401-3059
US

IV. Provider business mailing address

1306 CONCOURSE DR STE 201
LINTHICUM MD
21090-1033
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-2260
  • Fax:
Mailing address:
  • Phone: 410-384-9311
  • Fax: 410-384-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ANGELA RUTH PETERMAN
Title or Position: MD
Credential:
Phone: 443-351-3376