Provider Demographics
NPI:1386736429
Name:GREENSBORO PODIATRY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:GREENSBORO PODIATRY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AJLOUNY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:336-299-0271
Mailing Address - Street 1:530 N ELAM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1153
Mailing Address - Country:US
Mailing Address - Phone:336-299-0271
Mailing Address - Fax:336-299-8117
Practice Address - Street 1:530 N ELAM AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1153
Practice Address - Country:US
Practice Address - Phone:336-299-0271
Practice Address - Fax:336-299-8117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC425213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890804YMedicaid
NCU81337Medicare UPIN
NC890804YMedicaid
2433617BMedicare PIN