Provider Demographics
NPI:1164427704
Name:POSTAL, JANICE (DPM)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:POSTAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SPRING ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4003
Mailing Address - Country:US
Mailing Address - Phone:301-681-6008
Mailing Address - Fax:301-681-8908
Practice Address - Street 1:1111 SPRING ST
Practice Address - Street 2:SUITE 214
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4003
Practice Address - Country:US
Practice Address - Phone:301-681-6008
Practice Address - Fax:301-681-8908
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD960213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41937701OtherBLUE SHIELD
DC5598-0001OtherBLUE CROSS BLUE SHIELD NCA
MD32445OtherMAMSI
MD479168100Medicaid
MD152716Medicare PIN
MD480007581Medicare PIN
MDT30943Medicare UPIN