Provider Demographics
NPI:1528256005
Name:CHESAPEAKE FAMILY FOOT CARE, PA
Entity type:Organization
Organization Name:CHESAPEAKE FAMILY FOOT CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBORJA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-822-0991
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8912
Mailing Address - Country:US
Mailing Address - Phone:410-822-0991
Mailing Address - Fax:410-822-0577
Practice Address - Street 1:3708 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2025
Practice Address - Country:US
Practice Address - Phone:410-822-0991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD789MMedicare PIN