NPIMap

Organization Active NPI

Anne Arundel Dermatology Affiliates PC

  • Dermatology Physician
  • Hunt Valley, MD
National Provider Identifier
1083200794
Registry record updated Apr 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ANNE ARUNDEL DERMATOLOGY AFFILIATES PC
Practice address
54 Scott Adam Rd Ste 301
Hunt Valley, MD 21030-3360
Phone
(443) 351-3376
NPI assigned
Dec 16, 2020
Last updated
Apr 23, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ANNE ARUNDEL DERMATOLOGY, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Ruth Peterman
Title
MD
Phone
(443) 351-3376

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Procedural Dermatology Physician 207NS0135X NU
Dermatopathology (Pathology) Physician 207ZD0900X NU

Addresses

Primary practice location

54 Scott Adam Rd Ste 301
Hunt Valley, MD 21030-3360

Mailing address

1306 Concourse Dr Ste 201
Linthicum, MD 21090-1033
Phone (410) 384-9311

Other practice location 1

125 Market St
Virginia Beach, VA 23462-6794
Phone (443) 351-3376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210215001380 VA Part B Supplier - Clinic/Group Practice 1153736632 Receives reassigned benefits from 2 practitioners
Practice locations: Virginia Beach, VA

National Provider Directory

National Provider Directory
Part of
Robert Handwerger MD

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1083200794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 CONCOURSE DR STE 201",
            "city": "LINTHICUM",
            "state": "MD",
            "postal_code": "210901033",
            "telephone_number": "410-384-9311",
            "fax_number": "410-384-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 SCOTT ADAM RD STE 301",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210303360",
            "telephone_number": "443-351-3376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Market St",
            "address_purpose": "LOCATION",
            "city": "Virginia Beach",
            "state": "VA",
            "postal_code": "234626794",
            "country_code": "US",
            "telephone_number": "443-351-3376",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANNE ARUNDEL DERMATOLOGY AFFILIATES PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE ARUNDEL DERMATOLOGY, P.A.",
        "enumeration_date": "2020-12-16",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "PETERMAN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "RUTH",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "443-351-3376"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hunt Valley, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.