Provider Demographics
NPI:1710164363
Name:DEBRA R BOENDER DPM PHD LLC
Entity Type:Organization
Organization Name:DEBRA R BOENDER DPM PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-830-3338
Mailing Address - Street 1:405 FREDERICK RD
Mailing Address - Street 2:STE 154
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4646
Mailing Address - Country:US
Mailing Address - Phone:443-830-3338
Mailing Address - Fax:410-747-0535
Practice Address - Street 1:405 FREDERICK RD
Practice Address - Street 2:STE 154
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4646
Practice Address - Country:US
Practice Address - Phone:443-830-3338
Practice Address - Fax:410-747-0535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5373800001Medicare NSC