Provider Demographics
NPI:1326232612
Name:ENGLERT DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:ENGLERT DERMATOLOGY, LLC
Other - Org Name:ADVANCED DERMATOLOGY, BEL AIR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-472-1006
Mailing Address - Street 1:2012 S TOLLGATE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5900
Mailing Address - Country:US
Mailing Address - Phone:410-472-1006
Mailing Address - Fax:410-472-0900
Practice Address - Street 1:10 FILA WAY STE 205
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9454
Practice Address - Country:US
Practice Address - Phone:410-472-1006
Practice Address - Fax:410-472-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063690173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH37938Medicare UPIN