Provider Demographics
NPI:1184680043
Name:DEROY, ALAN ROBERT (DPM)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:ROBERT
Last Name:DEROY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7223 HANOVER PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2023
Mailing Address - Country:US
Mailing Address - Phone:301-441-2655
Mailing Address - Fax:301-441-2656
Practice Address - Street 1:7223 HANOVER PKWY STE B
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2023
Practice Address - Country:US
Practice Address - Phone:301-441-2655
Practice Address - Fax:301-441-2656
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300926213E00000X
MI5901002037213E00000X
MD01434213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD412480400Medicaid
MD019842R05Medicare PIN
MD412480400Medicaid
VAV07117Medicare UPIN