Provider Demographics
NPI:1750768313
Name:PODIATRY ASSOCIATES, P.A.
Entity type:Organization
Organization Name:PODIATRY ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-1212
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3592
Mailing Address - Country:US
Mailing Address - Phone:410-879-1763
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:9114 PHILADELPHIA RD STE 308
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4350
Practice Address - Country:US
Practice Address - Phone:410-574-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PODIATRY ASSOCIATES, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-04
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE602OtherBCBS-MD
MD600968902Medicaid
MDE602OtherBCBS-DC
MDE602OtherBCBS-DC