| NPI | 1336181668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIYA BOYCE Regional Credentialing Speicialist 301-933-7133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| 332900000X Non-Pharmacy Dispensing Site | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-02-26 |