Provider Demographics
NPI:1659673945
Name:ROBERT C FLOROS DPM PA
Entity Type:Organization
Organization Name:ROBERT C FLOROS DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FLOROS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-425-2111
Mailing Address - Street 1:20833 CALEB JONES RD
Mailing Address - Street 2:
Mailing Address - City:EWELL
Mailing Address - State:MD
Mailing Address - Zip Code:21824-9715
Mailing Address - Country:US
Mailing Address - Phone:410-425-2111
Mailing Address - Fax:
Practice Address - Street 1:20833 CALEB JONES RD
Practice Address - Street 2:
Practice Address - City:EWELL
Practice Address - State:MD
Practice Address - Zip Code:21824-9715
Practice Address - Country:US
Practice Address - Phone:410-425-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01448213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4784270001OtherMEDICARE IDENTIFICATION NUMBER
T30674Medicare UPIN