Provider Demographics
NPI:1467679530
Name:BALTIMORE PODIATRY GROUP, DR. BENJAMIN KLEINMAN, P.A.
Entity type:Organization
Organization Name:BALTIMORE PODIATRY GROUP, DR. BENJAMIN KLEINMAN, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-247-5333
Mailing Address - Street 1:5205 EAST DR
Mailing Address - Street 2:SUITE I
Mailing Address - City:ARBUTUS
Mailing Address - State:MD
Mailing Address - Zip Code:21227-2403
Mailing Address - Country:US
Mailing Address - Phone:410-247-5333
Mailing Address - Fax:410-242-5449
Practice Address - Street 1:5205 EAST DR
Practice Address - Street 2:SUITE I
Practice Address - City:ARBUTUS
Practice Address - State:MD
Practice Address - Zip Code:21227-2403
Practice Address - Country:US
Practice Address - Phone:410-247-5333
Practice Address - Fax:410-242-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6004181Medicaid
S113Medicare PIN
0649050002Medicare NSC