Provider Demographics
NPI:1376314393
Name:SCRUGGS PODIATRY, PC
Entity Type:Organization
Organization Name:SCRUGGS PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFORD-SCRUGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-653-7744
Mailing Address - Street 1:19 WALKER AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4078
Mailing Address - Country:US
Mailing Address - Phone:410-653-7744
Mailing Address - Fax:
Practice Address - Street 1:19 WALKER AVE STE 200
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4078
Practice Address - Country:US
Practice Address - Phone:410-653-7744
Practice Address - Fax:410-653-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty