Provider Demographics
NPI:1174833735
Name:DOVE PODIATRY PA
Entity Type:Organization
Organization Name:DOVE PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-870-3325
Mailing Address - Street 1:8817 BELAIR RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2445
Mailing Address - Country:US
Mailing Address - Phone:410-870-3325
Mailing Address - Fax:410-870-3631
Practice Address - Street 1:8817 BELAIR RD STE 109
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2445
Practice Address - Country:US
Practice Address - Phone:410-870-3325
Practice Address - Fax:410-870-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01030213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R049 0001OtherBCBS FED
MD544008400Medicaid
213259Medicare PIN
MD544008400Medicaid