Provider Demographics
NPI:1104584333
Name:CURRENT DERMATOLOGY AND COSMETIC CENTER LLC
Entity type:Organization
Organization Name:CURRENT DERMATOLOGY AND COSMETIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WALTERHOEFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-286-8831
Mailing Address - Street 1:309 TUCKER ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1340
Mailing Address - Country:US
Mailing Address - Phone:443-286-8831
Mailing Address - Fax:
Practice Address - Street 1:810 BESTGATE RD STE 450
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3648
Practice Address - Country:US
Practice Address - Phone:410-384-3045
Practice Address - Fax:410-384-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-06
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty