Provider Demographics
NPI:1184747479
Name:CIMAGLIA FOOT CARE, PLLC
Entity type:Organization
Organization Name:CIMAGLIA FOOT CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIMAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-533-2940
Mailing Address - Street 1:311 NORTH 4TH STREET, SUITE 4
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1371
Mailing Address - Country:US
Mailing Address - Phone:301-533-2940
Mailing Address - Fax:301-533-2942
Practice Address - Street 1:311 NORTH 4TH STREET, SUITE 4
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1371
Practice Address - Country:US
Practice Address - Phone:301-533-2940
Practice Address - Fax:301-533-2942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00337213E00000X
MD01261213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61489306 KFT9OtherBLUECROSSBLUESHIELD
MD1255339511OtherINDIVIDUAL NPI
MD616600800Medicaid
MD7308039MD2OtherMAMSI-MDIPA-OPTCHOICE
WV0100089000Medicaid
WV=========0001OtherMTST BCBS
WV0100089000Medicaid
MD61489306 KFT9OtherBLUECROSSBLUESHIELD
MD616600800Medicaid
WVCI9337831 CI0856044Medicare ID - Type UnspecifiedGROUP AND INDIVIDUAL NUMB
WV=========0001OtherMTST BCBS
MD4760610002Medicare NSC