Provider Demographics
NPI:1932135951
Name:RENAISSANCE FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:RENAISSANCE FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APARNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGIRALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-441-2655
Mailing Address - Street 1:7203 HANOVER PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2088
Mailing Address - Country:US
Mailing Address - Phone:301-441-2655
Mailing Address - Fax:301-441-2656
Practice Address - Street 1:7203 HANOVER PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2088
Practice Address - Country:US
Practice Address - Phone:301-441-2655
Practice Address - Fax:301-441-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1720044688OtherINDIVIDUAL NPI
MD1720044688OtherINDIVIDUAL NPI
MD5644740001Medicare NSC