MEDICARE: ANNE ARUNDEL DERMATOLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1033949755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANNE ARUNDEL DERMATOLOGY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 23329
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-3329
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 UPPER CHESAPEKE DR PAVILLION III
Second Line	:	SUITE 415
City	:	BEL AIR
State	:	MD
Zip	:	21014-4336
Country	:	US
Telephone Number	:	443-351-3376
Fax Number	:	443-787-4389

Authorized Official
Title or Position	:	MD
Name	:	ANGELA RUTH PETERMAN
Credential	:
Telephone Number	:	443-351-3376

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	04/10/2026

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