Healthcare Provider Details

I. General information

NPI: 1982549895
Provider Name (Legal Business Name): ANNE ARUNDEL DERMATOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 LANDMARK DR STE 120-122
GLEN BURNIE MD
21061-4987
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 443-351-3376
  • Fax: 410-766-4177
Mailing address:
  • Phone:
  • Fax:

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: NICOLE PROFFITT
Title or Position: DIR OF CREDENTIALING ENROLLMENT
Credential:
Phone: 804-869-6269