Provider Demographics
NPI:1508976606
Name:FOOT SPECIALISTS
Entity Type:Organization
Organization Name:FOOT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BENIJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-562-3338
Mailing Address - Street 1:1328 SOUTHERN AVE SE #200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:202-562-3338
Mailing Address - Fax:202-562-5351
Practice Address - Street 1:1328 SOUTHERN AVE SE #200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-562-3338
Practice Address - Fax:202-562-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC311213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC421336Medicare ID - Type Unspecified
T73357Medicare UPIN