Provider Demographics
NPI:1265459606
Name:MANN & HENRY PODIATRY SERVICES, LLC
Entity Type:Organization
Organization Name:MANN & HENRY PODIATRY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-334-1825
Mailing Address - Street 1:7101 GUILFORD DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5193
Mailing Address - Country:US
Mailing Address - Phone:301-694-8880
Mailing Address - Fax:301-663-0959
Practice Address - Street 1:7101 GUILFORD DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5193
Practice Address - Country:US
Practice Address - Phone:301-694-8880
Practice Address - Fax:301-663-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01223213E00000X, 213ES0103X
PASC004183R213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015596180001Medicaid
PA0015596180004Medicaid
MD549685364Medicaid
PA1255324539Medicaid
MD410156100Medicaid
PA1017481350001Medicaid
MD549685364Medicaid
MD5362690001Medicare NSC
MD065NMedicare PIN
PA817166UEEMedicare PIN
PA092541Medicare PIN
PAU56941Medicare UPIN
PA0015596180004Medicaid