Provider Demographics
NPI:1063697639
Name:BRUCE FOX DPM PA
Entity type:Organization
Organization Name:BRUCE FOX DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-589-7663
Mailing Address - Street 1:8505 FENTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4497
Mailing Address - Country:US
Mailing Address - Phone:301-589-7663
Mailing Address - Fax:301-589-3410
Practice Address - Street 1:8505 FENTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4497
Practice Address - Country:US
Practice Address - Phone:301-589-7663
Practice Address - Fax:301-589-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01336335E00000X, 261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4228680003Medicare NSC