Provider Demographics
NPI:1689052888
Name:PODIATRY ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-1212
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3592
Mailing Address - Country:US
Mailing Address - Phone:410-879-1763
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:6569 N CHARLES ST
Practice Address - Street 2:SUITE 702
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6831
Practice Address - Country:US
Practice Address - Phone:410-828-5420
Practice Address - Fax:410-821-5833
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRY ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-08
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE602OtherBCBS-DC
MD600968904Medicaid
MDE602OtherBCBS-MD
MDE602OtherBCBS-DC