Provider Demographics
NPI:1629151279
Name:FAMILY FOOTCARE
Entity Type:Organization
Organization Name:FAMILY FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-282-6666
Mailing Address - Street 1:1123 MERRITT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1438
Mailing Address - Country:US
Mailing Address - Phone:410-282-6666
Mailing Address - Fax:410-282-0357
Practice Address - Street 1:1123 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1438
Practice Address - Country:US
Practice Address - Phone:410-282-6666
Practice Address - Fax:410-282-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM00338213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD311830OtherBC/BS
R483OtherBC/BS FEDERAL
R483OtherBC/BS FEDERAL
H684Medicare ID - Type Unspecified