Provider Demographics
NPI:1871716860
Name:PODIATRY AFFILIATES, P.A.
Entity type:Organization
Organization Name:PODIATRY AFFILIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BOOK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:410-583-8898
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:410-803-0788
Mailing Address - Fax:410-803-1859
Practice Address - Street 1:700 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2350
Practice Address - Country:US
Practice Address - Phone:410-539-3362
Practice Address - Fax:410-752-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS394Medicare ID - Type Unspecified
MDS394161XMedicare PIN
MDS394115XMedicare PIN