NPIMap

Anne Arundel Dermatology, P.a.

Organization Active NPI Specialist · Havre de Grace, MD

NPI 1386474005 · NPPES record last updated Aug 7, 2024

Key facts

NPI
1386474005
Entity type
Organization (NPI type 2)
Primary specialty
Specialist 174400000X
Legal business name
ANNE ARUNDEL DERMATOLOGY, P.A.
Practice address
930 Revolution St
Havre de Grace, MD 21078-3718
Phone
(410) 939-0961
Fax
(410) 939-7832
NPI assigned
Aug 6, 2024
Organization subpart
Yes
Parent organization (as reported)
ANNE ARUNDEL DERMATOLOGY, P.A.

Authorized official

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

Corporate family (same tax ID) 35

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

View all 35

National Provider Directory

Tax ID family
R L Handwerger MD PA (36 organizations share this tax ID)
Part of
R L Handwerger MD PA

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist
Group: 193400000X SINGLE SPECIALTY GROUP		 174400000X Yes

Addresses

Primary practice location

930 Revolution St
Havre de Grace, MD 21078-3718

Mailing address

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 7, 2024.

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1386474005",
    "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": "930 REVOLUTION ST",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210783718",
            "telephone_number": "410-939-0961",
            "fax_number": "410-939-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNE ARUNDEL DERMATOLOGY, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE ARUNDEL DERMATOLOGY, P.A.",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Havre de Grace, MD

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Sources for this page

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