Provider Demographics
NPI:1912383910
Name:AFFILIATED PODIATRISTS PA
Entity Type:Organization
Organization Name:AFFILIATED PODIATRISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-825-2443
Mailing Address - Street 1:7402 YORK RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7532
Mailing Address - Country:US
Mailing Address - Phone:410-825-2443
Mailing Address - Fax:410-321-7040
Practice Address - Street 1:2300 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2739
Practice Address - Country:US
Practice Address - Phone:410-825-2443
Practice Address - Fax:410-321-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDW00473314000000X
MD01561314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD981408624Medicaid