Provider Demographics
NPI:1598199796
Name:HAGERSTOWN DERM AND SKIN CARE
Entity Type:Organization
Organization Name:HAGERSTOWN DERM AND SKIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FANGMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-469-4835
Mailing Address - Street 1:13424 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2658
Mailing Address - Country:US
Mailing Address - Phone:301-370-6688
Mailing Address - Fax:
Practice Address - Street 1:1136 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:240-469-4835
Practice Address - Fax:240-469-4836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty