Healthcare Provider Details

I. General information

NPI: 1407418924
Provider Name (Legal Business Name): AMANDA RAE ARREOLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 UPPER CHESAPEAKE DR PAVILION III SUITE 415
BEL AIR MD
21014
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-0961
  • Fax: 443-787-4389
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD225536
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0107744
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: