Provider Demographics
NPI:1578947305
Name:LARRY S. HOTCHKISS, DPM PC
Entity Type:Organization
Organization Name:LARRY S. HOTCHKISS, DPM PC
Other - Org Name:SOUTHERN MARYLAND FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-868-3506
Mailing Address - Street 1:12070 OLD LINE CTR
Mailing Address - Street 2:#110
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:#110
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-868-3506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site