Provider Demographics
NPI:1497282149
Name:LANSDOWNE PODIATRY
Entity Type:Organization
Organization Name:LANSDOWNE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:571-223-0424
Mailing Address - Street 1:44135 WOODRIDGE PKWY
Mailing Address - Street 2:SUITE180
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8282
Mailing Address - Country:US
Mailing Address - Phone:571-223-0424
Mailing Address - Fax:
Practice Address - Street 1:10845 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-1717
Practice Address - Country:US
Practice Address - Phone:410-335-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies