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NPI Code Detail

MEDICARE: ANNE ARUNDEL DERMATOLOGY, P.A.

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
1174400000XSpecialist
2207N00000XDermatology Physician
3207ND0101XMOHS-Micrographic Surgery Physician

General Provider Information

NPI Number : 1083448039
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANNE ARUNDEL DERMATOLOGY, P.A.
Provider Business Mailing Address
First Line : 1306 CONCOURSE DR STE 201
Second Line :
City : LINTHICUM HEIGHTS
State : MD
Zip : 21090-1033
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 180 ADMIRAL COCHRANE DR STE 430
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-8405
Country : US
Telephone Number : 410-263-5439
Fax Number :
Authorized Official
Title or Position : MD
Name : ANGELA RUTH PETERMAN
Credential :
Telephone Number : 443-351-3376
Provider Enumeration Date : 08/30/2024
Last Update Date : 08/30/2024

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