Provider Demographics
NPI: | 1841385192 |
---|---|
Name: | ZAIDERMAN, ISIDORE NONE (DPM) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ISIDORE |
Middle Name: | NONE |
Last Name: | ZAIDERMAN |
Suffix: | |
Gender: | M |
Credentials: | DPM |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1808 CONNECTICUT AVE NW |
Mailing Address - Street 2: | |
Mailing Address - City: | WASHINGTON |
Mailing Address - State: | DC |
Mailing Address - Zip Code: | 20009-5729 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 202-332-3898 |
Mailing Address - Fax: | 202-387-7798 |
Practice Address - Street 1: | 1808 CONNECTICUT AVE NW |
Practice Address - Street 2: | |
Practice Address - City: | WASHINGTON |
Practice Address - State: | DC |
Practice Address - Zip Code: | 20009-5729 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-332-3898 |
Practice Address - Fax: | 202-387-7798 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-10-03 |
Last Update Date: | 2023-09-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DC | P0245 | 213EP1101X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 213EP1101X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DC | 154134 | Medicare ID - Type Unspecified | MEDICARE PARTICIPATION # |
MD | 728R | Medicare ID - Type Unspecified | MEDICARE PARTICIPATING # |