Provider Demographics
NPI:1730361940
Name:ENGLERT DERMATOLOGY LLC
Entity type:Organization
Organization Name:ENGLERT DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CRNP
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:410-569-5151
Mailing Address - Street 1:P O BOX 791079
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279
Mailing Address - Country:US
Mailing Address - Phone:410-569-5151
Mailing Address - Fax:410-569-1131
Practice Address - Street 1:10 FILA WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152
Practice Address - Country:US
Practice Address - Phone:410-569-5151
Practice Address - Fax:410-569-1131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD209PMedicare PIN