Provider Demographics
NPI:1285809715
Name:LARRY S. HOTCHKISS, DPM, LLC
Entity type:Organization
Organization Name:LARRY S. HOTCHKISS, DPM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-580-8338
Mailing Address - Street 1:12070 OLD LINE CTR STE 110
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2503
Mailing Address - Country:US
Mailing Address - Phone:301-843-9581
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:STE 102
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-868-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3913200001Medicare NSC
DC192156Medicare PIN
MD325PMedicare PIN