Healthcare Provider Details

I. General information

NPI: 1366372815
Provider Name (Legal Business Name): ANNE ARUNDEL DERMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ADMIRAL COCHRANE DR STE 430
ANNAPOLIS MD
21401-8405
US

IV. Provider business mailing address

180 ADMIRAL COCHRANE DR STE 430
ANNAPOLIS MD
21401-8405
US

V. Phone/Fax

Practice location:
  • Phone: 410-263-5439
  • Fax:
Mailing address:
  • Phone: 410-263-5439
  • Fax: 410-263-7482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LISA LONSINGER
Title or Position: BILLING
Credential:
Phone: 443-618-1085