Provider Demographics
NPI:1447285788
Name:FAMILY PODIATRY OF MARYLAND, LLC
Entity type:Organization
Organization Name:FAMILY PODIATRY OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANG
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-833-2255
Mailing Address - Street 1:4 GLYNDON DR
Mailing Address - Street 2:STE. 2A
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-2000
Mailing Address - Country:US
Mailing Address - Phone:410-833-2255
Mailing Address - Fax:410-833-9211
Practice Address - Street 1:4 GLYNDON DR STE 2A
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-2002
Practice Address - Country:US
Practice Address - Phone:410-833-2255
Practice Address - Fax:410-833-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01288213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD613874-08OtherBLUECROSS BLUESHIELD
MD404184400Medicaid
MD5733540001Medicare NSC
MDU80097Medicare UPIN
MD280PMedicare PIN