MEDICARE: UNIVERSITY OF MARYLAND DERMATOLOGISTS PA

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1861368946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MARYLAND DERMATOLOGISTS PA

Provider Business Mailing Address
First Line	:	PO BOX 64445
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4445
Country	:	US
Telephone Number	:	410-328-5767
Fax Number	:	410-328-0098

Provider Business Practice Location Address
First Line	:	6021 UNIVERSITY BLVD STE 370-390
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6077
Country	:	US
Telephone Number	:	667-214-1171
Fax Number	:

Authorized Official
Title or Position	:	REIMBURSEMENT OPS CREDENTIALING SPE
Name	:	KATELYN PETTIT
Credential	:
Telephone Number	:	667-214-1353

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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