Provider Demographics
NPI:1851394027
Name:BOENDER, DEBRA R (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:BOENDER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26553 MARINERS RD
Mailing Address - Street 2:
Mailing Address - City:CRISFIELD
Mailing Address - State:MD
Mailing Address - Zip Code:21817-2109
Mailing Address - Country:US
Mailing Address - Phone:443-799-5500
Mailing Address - Fax:
Practice Address - Street 1:26553 MARINERS RD
Practice Address - Street 2:
Practice Address - City:CRISFIELD
Practice Address - State:MD
Practice Address - Zip Code:21817-2109
Practice Address - Country:US
Practice Address - Phone:443-799-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01409213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD002485895002OtherUNITED HEALTHCARE
MDRR DC9138OtherRR MEDICARE
MD01409OtherPODIATRY LICENSE MARYLAND
MD201663779OtherPOMCO
MD5373800001OtherDME
MD002216100Medicaid
MD201663779OtherGREAT WEST
MD201663779OtherCARE IMPROVEMENT PLUS
MD606937400OtherFED WORKERS COMP
MD2137828OtherONE NET
MDK4150001OtherBC/BS FED, DC, B CHOICE
MD689BPO/644903-01OtherCAREFIRST BC/BS
MD201663779OtherGREAT WEST
MD201663779OtherEIN
MDV01247Medicare UPIN
MD045N890FMedicare PIN
MD01409OtherPODIATRY LICENSE MARYLAND