MEDICARE: LASER PODIATRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	01423	MD

General Provider Information

NPI Number	:	1699144758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LASER PODIATRY

Provider Business Mailing Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE B3
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	301-829-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 TWIN ARCH RD
Second Line	:	SUITE B3
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-4138
Country	:	US
Telephone Number	:	301-829-5111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER MULLENDORE
Credential	:	DPM
Telephone Number	:	301-829-5111

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	09/18/2015

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Directions to “LASER PODIATRY ” Practice Location

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