Provider Demographics
NPI:1184763583
Name:BUBSER, JOHN EDWIN (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWIN
Last Name:BUBSER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8700 CENTRAL AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4831
Mailing Address - Country:US
Mailing Address - Phone:301-499-3338
Mailing Address - Fax:301-499-1266
Practice Address - Street 1:8700 CENTRAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4831
Practice Address - Country:US
Practice Address - Phone:301-499-3338
Practice Address - Fax:301-499-1266
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01202213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199P456GMedicare PIN
U51222Medicare UPIN
DC5586900001Medicare NSC
MD5586900002Medicare NSC
DCG01448J01Medicare PIN