NPIMap

Organization Active NPI

Anne Arundel Dermatology, PA

  • MOHS-Micrographic Surgery Physician
  • Glen Burnie, MD
National Provider Identifier
1982549895
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
Legal business name
ANNE ARUNDEL DERMATOLOGY, PA
Practice address
810 Landmark Dr Ste 120-122
Glen Burnie, MD 21061-4987
Phone
(443) 351-3376
Fax
(410) 766-4177
NPI assigned
Apr 20, 2026
Last updated
Apr 20, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ANNE ARUNDEL DERMATOLOGY, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2026

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

Authorized official

Name
Nicole Proffitt
Title
Dir of Credentialing Enrollment
Phone
(804) 869-6269

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X NU Primary

Addresses

Primary practice location

810 Landmark Dr Ste 120-122
Glen Burnie, MD 21061-4987

Mailing address

PO Box 23329
New York, NY 10087-3329

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

810 Landmark Dr
Ste 120122
Glen Burnie, MD 21061

Practitioners & affiliated clinicians

Practitioners 1

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": "1776643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776643200000",
    "number": "1982549895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 23329",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100873329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 LANDMARK DR STE 120-122",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210614987",
            "telephone_number": "443-351-3376",
            "fax_number": "410-766-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNE ARUNDEL DERMATOLOGY, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ANNE ARUNDEL DERMATOLOGY, PA",
        "enumeration_date": "2026-04-20",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "status": "A",
        "authorized_official_last_name": "PROFFITT",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIR OF CREDENTIALING  ENROLLMENT",
        "authorized_official_telephone_number": "804-869-6269"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Burnie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2026; 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.