Provider Demographics
NPI:1861368946
Name:UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Entity type:Organization
Organization Name:UNIVERSITY OF MARYLAND DERMATOLOGISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REIMBURSEMENT OPS CREDENTIALING SPE
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-214-1353
Mailing Address - Street 1:PO BOX 64445
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4445
Mailing Address - Country:US
Mailing Address - Phone:410-328-5767
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:6021 UNIVERSITY BLVD STE 370-390
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6077
Practice Address - Country:US
Practice Address - Phone:667-214-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty