MEDICARE: ADVANCED PEDORTHICS, LLC.

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	335E00000X	Prosthetic/Orthotic Supplier	03836323	MD

General Provider Information

NPI Number	:	1790187110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PEDORTHICS, LLC.

Provider Business Mailing Address
First Line	:	5411 OLD FREDERICK RD SUITE 10
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229
Country	:	US
Telephone Number	:	443-844-6395
Fax Number	:	410-788-7785

Provider Business Practice Location Address
First Line	:	5411 OLD FREDERICK RD STE 10
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-2126
Country	:	US
Telephone Number	:	443-844-6395
Fax Number	:	410-788-7785

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL GOLDMAN
Credential	:	CETIFIED PEDORTHIST
Telephone Number	:	443-844-6395

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	09/02/2020

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