Provider Demographics
NPI:1407946882
Name:PODIATRIC PHYSICIANS & SURGEONS, LLC
Entity Type:Organization
Organization Name:PODIATRIC PHYSICIANS & SURGEONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:STANCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-420-2801
Mailing Address - Street 1:215 FULFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3813
Mailing Address - Country:US
Mailing Address - Phone:410-420-2801
Mailing Address - Fax:410-420-2803
Practice Address - Street 1:215 FULFORD AVE
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3813
Practice Address - Country:US
Practice Address - Phone:410-420-2801
Practice Address - Fax:410-420-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU87701Medicare UPIN
MD170MMedicare PIN
MD4498290001Medicare NSC