Provider Demographics
NPI:1194906842
Name:PODIATRY ASSOCIATES PA
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-420-4325
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3592
Mailing Address - Country:US
Mailing Address - Phone:410-879-1763
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:1 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3592
Practice Address - Country:US
Practice Address - Phone:410-879-1763
Practice Address - Fax:410-803-1859
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRY ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-23
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00527213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD600968907Medicaid
1815OtherCAREFIRST
MD745960200Medicaid
MD745960200Medicaid
MDH792Medicare PIN
1815OtherCAREFIRST