Provider Demographics
NPI:1295165025
Name:WESTMINSTER DERMATOLOGY, LLC
Entity type:Organization
Organization Name:WESTMINSTER DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:410-596-8609
Mailing Address - Street 1:306 JASONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21158-3548
Mailing Address - Country:US
Mailing Address - Phone:410-596-8609
Mailing Address - Fax:
Practice Address - Street 1:410 MEADOW CREEK DR
Practice Address - Street 2:SUITE 209
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21158-9426
Practice Address - Country:US
Practice Address - Phone:410-596-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty