1154708618 NPI number — PODIATRY ASSOCIATES, P.A.

Table of content: (NPI 1154708618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154708618 NPI number — PODIATRY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRY ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154708618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-3592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-879-1763
Provider Business Mailing Address Fax Number:
410-803-1859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9712 BELAIR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-256-6060
Provider Business Practice Location Address Fax Number:
410-256-2727
Provider Enumeration Date:
05/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-879-1212

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 600968905 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: E602 . This is a "BCBS-MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: E602 . This is a "BCBS-DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com