Healthcare Provider Details

I. General information

NPI: 1255907622
Provider Name (Legal Business Name): CAMILLE ALYSSA BULTE-CHOUDHRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE ALYSSA BULTE MD

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 BESTGATE RD STE 450
ANNAPOLIS MD
21401-3717
US

IV. Provider business mailing address

810 BESTGATE RD STE 450
ANNAPOLIS MD
21401-3717
US

V. Phone/Fax

Practice location:
  • Phone: 410-384-3045
  • Fax: 410-384-3044
Mailing address:
  • Phone: 410-384-3045
  • Fax: 410-384-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0104352
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberD0104352
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: