Provider Demographics
NPI:1164427704
Name:POSTAL, JANICE (DPM)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:POSTAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 ROCKVILLE PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3142
Mailing Address - Country:US
Mailing Address - Phone:301-681-6008
Mailing Address - Fax:301-681-8908
Practice Address - Street 1:11125 ROCKVILLE PIKE STE 203
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-681-6008
Practice Address - Fax:301-681-8908
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD960213EP1101X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD41937701OtherBLUE SHIELD
MD479168100Medicaid
MD32445OtherMAMSI
DC5598-0001OtherBLUE CROSS BLUE SHIELD NCA
MD152716Medicare PIN
MD480007581Medicare PIN
MDT30943Medicare UPIN