Provider Demographics
NPI:1568169837
Name:GREATER WASHINGTON ADVANCE PODIATRY, INC
Entity Type:Organization
Organization Name:GREATER WASHINGTON ADVANCE PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-717-0366
Mailing Address - Street 1:13337 COPPER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3454
Mailing Address - Country:US
Mailing Address - Phone:301-515-3338
Mailing Address - Fax:301-560-5919
Practice Address - Street 1:19525 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-5262
Practice Address - Country:US
Practice Address - Phone:301-515-3338
Practice Address - Fax:301-560-5919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404899700Medicaid