Provider Demographics
NPI:1427353408
Name:JOHN CHARLTON PODIATRY PA
Entity type:Organization
Organization Name:JOHN CHARLTON PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHARLTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-433-1122
Mailing Address - Street 1:5013 ROLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2295
Mailing Address - Country:US
Mailing Address - Phone:410-433-1122
Mailing Address - Fax:410-433-1122
Practice Address - Street 1:5013 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2295
Practice Address - Country:US
Practice Address - Phone:410-433-1122
Practice Address - Fax:410-433-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD01077213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1932205994/W299OtherCFBC/BS
MD0906085Medicaid
MD480033528OtherRRMC
MD10227357OtherAMERICAID
MDT304/1932205994OtherCAREFIRST BC/BS
MD480033528OtherRRMC