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	:	1144050832
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	:	3430 WORTHINGTON BLVD STE 205
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21704-7019
Country	:	US
Telephone Number	:	301-378-9590
Fax Number	:	301-732-4878

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	:	08/07/2024

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