Provider Demographics
NPI:1033315031
Name:MOTRAN, JOHNY J (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHNY
Middle Name:J
Last Name:MOTRAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86284
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-6284
Mailing Address - Country:US
Mailing Address - Phone:301-519-3668
Mailing Address - Fax:301-519-7461
Practice Address - Street 1:8903 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1308
Practice Address - Country:US
Practice Address - Phone:301-519-3668
Practice Address - Fax:301-519-7461
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01450213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6342390001Medicare NSC
MD170455ZFJ1Medicare PIN