Provider Demographics
NPI:1740349596
Name:LANDIS PODIATRY LLC
Entity type:Organization
Organization Name:LANDIS PODIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-256-1188
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-0371
Mailing Address - Country:US
Mailing Address - Phone:410-256-1188
Mailing Address - Fax:410-256-1188
Practice Address - Street 1:4136 E JOPPA RD
Practice Address - Street 2:SUITE L
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2286
Practice Address - Country:US
Practice Address - Phone:410-256-1188
Practice Address - Fax:410-256-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00890213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT217Medicare ID - Type Unspecified
1710928973Medicare UPIN