Provider Demographics
NPI:1386024057
Name:BALTIMORE PODIATRY GROUP, DR. BENJAMIN KLEINMAN, P.A.
Entity Type:Organization
Organization Name:BALTIMORE PODIATRY GROUP, DR. BENJAMIN KLEINMAN, P.A.
Other - Org Name:BALTIMORE PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-247-5333
Mailing Address - Street 1:5205 EAST DRIVE, SUITE I
Mailing Address - Street 2:
Mailing Address - City:ARBUTUS
Mailing Address - State:MD
Mailing Address - Zip Code:21227
Mailing Address - Country:US
Mailing Address - Phone:410-247-5333
Mailing Address - Fax:410-242-5449
Practice Address - Street 1:2300 GARRISON BLVD., SUITE 105
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216
Practice Address - Country:US
Practice Address - Phone:410-624-3338
Practice Address - Fax:410-624-3358
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BALTIMORE PODIATRY GROUP, DR. BENJAMIN KLEINMAN, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6004181Medicaid
MDS113Medicare PIN