Healthcare Provider Details

I. General information

NPI: 1679307722
Provider Name (Legal Business Name): ANNE ARUNDEL DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 ROCKLEDGE DR STE 300
BETHESDA MD
20817-7811
US

IV. Provider business mailing address

1306 CONCOURSE DR STE 201
LINTHICUM HEIGHTS MD
21090-1033
US

V. Phone/Fax

Practice location:
  • Phone: 301-564-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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