| NPI | 1760934186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVONDA L KEATING Sr Production Unit Mgr 410-933-6430 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: MD 520595510) |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213EP1101X Podiatrist Primary Podiatric Medicine | |
| 213ES0000X Podiatrist Sports Medicine | |
| 213ES0103X Podiatrist Foot & Ankle Surgery | |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2025-05-07 |