Provider Demographics
NPI:1992920557
Name:MITCHELLVILLE FOOT HEALTH, PC
Entity type:Organization
Organization Name:MITCHELLVILLE FOOT HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER-PERPALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-805-9308
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20718-1397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7401 FORBES BLVD
Practice Address - Street 2:SUITE B-2
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2200
Practice Address - Country:US
Practice Address - Phone:301-805-9308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00648213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT31205Medicare UPIN
5908280001Medicare NSC