Provider Demographics
NPI:1922190289
Name:FOOT CARE CONSULTANTS. PA
Entity Type:Organization
Organization Name:FOOT CARE CONSULTANTS. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-981-7900
Mailing Address - Street 1:6300 W PARKER ROAD
Mailing Address - Street 2:STE 420
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093
Mailing Address - Country:US
Mailing Address - Phone:972-981-7900
Mailing Address - Fax:972-981-7781
Practice Address - Street 1:6300 W PARKER ROAD
Practice Address - Street 2:STE 420
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093
Practice Address - Country:US
Practice Address - Phone:972-981-7900
Practice Address - Fax:972-981-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP1106213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID NUMBER
TX00R88TMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX=========OtherTAX ID NUMBER