# CLARKSBURG DERMATOLOGY AND SKINCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316439078
- **Authorized official:** JOHANNA FANGMEYER CRNP (OWNER)
- **Authorized official phone:** (301) 298-1818

## Contact information

- **Practice address:** 23202 BREWERS TAVERN WAY, CLARKSBURG, MD 20871
- **Practice address phone:** (301) 298-1818
- **Practice address fax:** (301) 540-1865
- **Mailing address:** 1136 OPAL CT, HAGERSTOWN, MD 21740-5940
- **Mailing address phone:** (800) 430-6311
- **Mailing address fax:** (240) 469-4836

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | R134352 | MD | Yes |

## Other

- **Enumeration date:** 05/30/2018
- **Last updated:** 07/12/2018