NPIMap

Organization Active NPI

Anne Arundel Dermatology, PA

  • Dermatology Physician
  • Vienna, VA
National Provider Identifier
1235958794
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
ANNE ARUNDEL DERMATOLOGY, PA
Practice address
2236C Gallows Rd FL 2
Vienna, VA 22182-5200
Phone
(703) 827-7008
NPI assigned
Oct 10, 2024
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ANNE ARUNDEL DERMATOLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2236C Gallows Rd FL 2
Vienna, VA 22182-5200

Mailing address

1306 Concourse Dr Ste 201
Linthicum Heights, MD 21090-1033

Other names 1

  • Anne Arundel Dermatology, PA Other name

National Provider Directory

National Provider Directory
Tax ID family
Anne Arundel Dermatology PA36 organizations share this tax ID, including this one
Part of
Anne Arundel Dermatology PA

Other organizations with this tax ID 35

Organizations that report the same tax identification number in the National Provider Directory.

View all 35

Locations

2236C Gallows Rd
Fl 2
Vienna, VA 22182
Phone (703) 827-7008

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1235958794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1306 CONCOURSE DR STE 201",
            "city": "LINTHICUM HEIGHTS",
            "state": "MD",
            "postal_code": "210901033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2236C GALLOWS RD FL 2",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221825200",
            "telephone_number": "703-827-7008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNE ARUNDEL DERMATOLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE ARUNDEL DERMATOLOGY, PA",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "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": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anne Arundel Dermatology, PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Vienna, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.