Healthcare Provider Details

I. General information

NPI: 1922838648
Provider Name (Legal Business Name): ANNE ARUNDEL DERMATOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CONNECTICUT AVE STE 210
CHEVY CHASE MD
20815-5837
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 240-482-2555
  • Fax: 240-482-2556
Mailing address:
  • Phone: 410-873-8500
  • Fax:

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: AO
Credential:
Phone: 410-384-9311