Provider Demographics
NPI:1154612158
Name:ADVANCE FOOT CARE AND MEDICAL SERVICES,LLC
Entity type:Organization
Organization Name:ADVANCE FOOT CARE AND MEDICAL SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR/MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-466-2124
Mailing Address - Street 1:4801 LIBERTY HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-7157
Mailing Address - Country:US
Mailing Address - Phone:410-466-2124
Mailing Address - Fax:410-466-2154
Practice Address - Street 1:4801 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7157
Practice Address - Country:US
Practice Address - Phone:410-466-2124
Practice Address - Fax:410-466-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty