Provider Demographics
NPI:1285259192
Name:PODIATRY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:CONDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-927-3510
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:410-879-1212
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:110 OLD PADONIA RD STE 301
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-4948
Practice Address - Country:US
Practice Address - Phone:410-628-1066
Practice Address - Fax:410-683-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1487879938Medicaid