Organization
ACADEMIC ALLIANCE IN DERMATOLOGY, INC
Active
Parent organization
ACADEMIC ALLIANCE IN DERMATOLOGY, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ACADEMIC ALLIANCE IN DERMATOLOGY, INC
Authorized official
ANGELA RUTH PETERMAN MD (PRESIDENT/OWNER)
(410) 766-0111
Entity
Organization
Contact information
Practice address
4238 W KENNEDY BLVD, TAMPA, FL 33609-2231
(813) 879-6040
(813) 879-6043
Mailing address
5210 WEBB RD, TAMPA, FL 33615-4518
(813) 882-9986
(813) 882-9849
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
06/04/2021
Last updated
04/22/2022
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