ANNE ARUNDEL DERMATOLOGY LLC
Complete NPI Record 1063481703
Dermatology in Annapolis, MD

Active since March 15, 2006CLIA Certified · 15 labs

2002 MEDICAL PKWY STE 630, ANNAPOLIS, MD 21401(410) 224-2260(410) 224-3090 Get Directions

NPPES record last updated: April 29, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 29, 2026, Mar 21, 2025, Aug 6, 2024 and 3 more (6 updates tracked since 2018).

Complete NPI Dataset

This page contains the complete raw NPPES record for Anne Arundel Dermatology Llc (NPI 1063481703), a dermatology organization in Annapolis, MD. All 43 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.

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Registry File Document Utilities

NPI: 1063481703: The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2: Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: Not available: The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business Name: ANNE ARUNDEL DERMATOLOGY LLC: The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address: PO BOX 23329: The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City Name: NEW YORK: The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NY: The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code: 100873329: The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Country Code If outside U S : US: The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
Provider Business Mailing Address Telephone Number: 4108738500: The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number: 4043019057: The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Provider First Line Business Practice Location Address: 2002 MEDICAL PKWY STE 630: The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ANNAPOLIS: The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: MD: The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 214013059: The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US: The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 4102242260: The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 4102243090: The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 3/15/2006: The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 4/29/2026: The date that a record was last updated or changed.
Authorized Official Last Name: WELCH: The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: MARK: The first name of the authorized official.
Authorized Official Middle Name: L: The middle name of the authorized official.
Authorized Official Title or Position: CHIEF MEDICAL OFFICER: The title or position of the authorized official.
Authorized Official Telephone Number: 2403053765: The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207ND0101X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 2: 207ZP0102X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 2: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 3: 207ZD0900X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 3: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 4: 207ND0900X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 4: N: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Healthcare Provider Taxonomy Code 5: 207N00000X: This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 5: Y: This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
Is Organization Subpart: N: Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
Authorized Official Credential Text: MD: The professional credential(s) of the authorized official listed on the provider's NPI record. Examples include MD (Doctor of Medicine), DO (Doctor of Osteopathy), RN (Registered Nurse), DDS (Doctor of Dental Surgery), PhD, or other recognized designations that reflect the official's qualifications.
Healthcare Provider Taxonomy Group 1: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 2: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 3: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 4: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Healthcare Provider Taxonomy Group 5: 193200000X MULTI-SPECIALTY GROUP: Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
NPI Certification Date: 4/29/2026: The date on which the National Provider Identifier (NPI) was officially assigned and certified to the provider. This reflects when the provider's NPI record first became active in the NPPES system.

Secondary Practice Locations 42

The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.

23503 Hollywood Rd Ste 102

1/42

Leonardtown, MD 20650-5925 · Phone (443) 351-3376 · Fax (301) 475-1881

2730 University Blvd W Ste 400

2/42

Silver Spring, MD 20902-1972 · Phone (301) 933-0960 · Fax (301) 933-1547

301 W Watersville Rd Ste 2

3/42

MOUNT AIRY, MD 21771-5868 · Phone (443) 351-3376 · Fax (301) 829-4187

3430 Worthington Blvd Ste 205

4/42

Urbana, MD 21704-7019 · Phone (301) 933-1547 · Fax (301) 732-4878

4 Caulk Ln Ste B

5/42

Easton, MD 21601-3808 · Phone (410) 822-8223 · Fax (410) 822-1423

410 Meadow Creek Dr Ste 205

6/42

Westminster, MD 21158-9455 · Phone (301) 829-4185 · Fax (301) 829-4187

9948 N Main St Unit 1

7/42

Berlin, MD 21811-1076 · Phone (410) 921-3376 · Fax (443) 736-1945

180 Admiral Cochrane Dr Ste 410

8/42

Annapolis, MD 21401-8405 · Phone (667) 383-7546 · Fax (410) 263-7482

180 Admiral Cochrane Dr Ste 420

9/42

Annapolis, MD 21401-8405 · Phone (667) 383-7546 · Fax (410) 263-5439

15225 Shady Grove Rd Ste 303

10/42

Rockville, MD 20850-3259 · Phone (301) 216-2980 · Fax (301) 216-2982

2002 Medical Pkwy Ste 630

11/42

Annapolis, MD 21401-3059 · Phone (410) 224-2260 · Fax (410) 224-3090

231 Najoles Rd Ste 300

12/42

Millersville, MD 21108-2670 · Phone (443) 351-3376 · Fax (443) 494-2303

180 Admiral Cochrane Dr Ste 430

13/42

Annapolis, MD 21401-8405 · Phone (410) 339-0760 · Fax (410) 263-7482

54 Scott Adam Rd Ste 301

14/42

Hunt Valley, MD 21030-3360 · Phone (410) 666-3960 · Fax (410) 666-3981

995 N Prince Frederick Blvd Ste 205

15/42

Prince Frederick, MD 20678-5101 · Phone (443) 351-3376 · Fax (410) 535-6574

510 Upper Chesapeake Dr Pavilion III Ste 415

16/42

Bel Air, MD 21014-4336 · Phone (410) 939-0961 · Fax (443) 787-4389

1035 Champions Way Ste 100

17/42

Suffolk, VA 23435-3762 · Phone (757) 967-0790 · Fax (757) 967-0793

12695 McManus Blvd Ste 4A-B

18/42

Newport News, VA 23602-4435 · Phone (757) 369-0439 · Fax (757) 369-0513

810 Landmark Dr Ste 120-122

19/42

Glen Burnie, MD 21061-4987 · Phone (443) 351-3376

8401 Connecticut Ave Ste 210

20/42

Chevy Chase, MD 20815-5837 · Phone (240) 482-2555 · Fax (240) 822-2556

8505 Arlington Blvd Ste 200

21/42

Fairfax, VA 22031-4630 · Phone (301) 564-3131 · Fax (301) 564-6391

930 Revolution St

22/42

Havre DE Grace, MD 21078-3718 · Phone (410) 939-0961 · Fax (410) 939-7832

7921 Jones Branch Dr Ste 320

23/42

Mc Lean, VA 22102-3334 · Phone (703) 827-7008 · Fax (703) 827-7011

810 Gleneagles Ct Ste 204

24/42

Towson, MD 21286-2236 · Phone (443) 351-3376 · Fax (410) 296-5463

810 Landmark Dr Ste 217-219

25/42

Glen Burnie, MD 21061-4987 · Phone (410) 766-1324 · Fax (410) 766-4177

11510 Old Georgetown Rd

26/42

Rockville, MD 20852-2736 · Phone (301) 881-4124 · Fax (301) 881-6505

1185 Imperial Dr Ste 201

27/42

Hagerstown, MD 21740-6673 · Phone (240) 707-3757 · Fax (301) 791-5234

115 Sallitt Drive East

28/42

Stevensville, MD 21666-2156 · Phone (443) 351-3376 · Fax (410) 643-3797

7101 Guilford Dr Ste 105

29/42

Frederick, MD 21704-5198 · Phone (855) 314-1425 · Fax (301) 694-9481

7501 Greenway Center Drive Fl 10 Ste 1000

30/42

Greenbelt, MD 20770-3513 · Phone (301) 345-7375 · Fax (301) 345-7269

7671 Quarterfield Rd Ste 200A

31/42

Glen Burnie, MD 21061-4407 · Phone (443) 351-3376 · Fax (410) 582-9155

7671 Quarterfield Rd Ste 200B

32/42

Glen Burnie, MD 21061-4407 · Phone (443) 351-3376 · Fax (410) 582-9155

995 N Prince Frederick Blvd Ste 204

33/42

Prince Frederick, MD 20678-5101 · Phone (443) 351-3376 · Fax (410) 535-6574

1069 Centerbrooke Ln

34/42

Suffolk, VA 23434-8475 · Phone (757) 925-1860 · Fax (757) 925-1863

10700 Charter Dr Ste 300

35/42

Columbia, MD 21044-3695 · Phone (667) 375-3376 · Fax (443) 249-7437

11351 Random Hills Rd Ste 200

36/42

Fairfax, VA 22030-6081 · Phone (571) 234-6078 · Fax (667) 464-3376

5630 Lowery Rd

37/42

Norfolk, VA 23502-2233 · Phone (757) 455-5009 · Fax (757) 362-3577

5977 Exchange Dr Ste C-D

38/42

Sykesville, MD 21784-9265 · Phone (443) 351-3376 · Fax (301) 829-4187

6410 Rockledge Dr Ste 300

39/42

Bethesda, MD 20817-7811 · Phone (301) 564-3131 · Fax (301) 564-6391

6410 Rockledge Dr Ste 402

40/42

Bethesda, MD 20817-7807 · Phone (301) 530-4800 · Fax (301) 531-1847

6163 Executive Blvd

41/42

Rockville, MD 20852-3901 · Phone (855) 314-1425 · Fax (301) 984-3001

125 Market St

42/42

Virginia Beach, VA 23462-6794 · Phone (757) 437-8900 · Fax (757) 437-8200

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