Healthcare Provider Details

I. General information

NPI: 1316930035
Provider Name (Legal Business Name): JOSEPH BLAISE GIRLANDO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2005
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7131 LIBERTY RD SUITE 104
BALTIMORE MD
21207-4575
US

IV. Provider business mailing address

7131 LIBERTY RD SUITE 104
BALTIMORE MD
21207-4575
US

V. Phone/Fax

Practice location:
  • Phone: 410-944-8805
  • Fax: 410-944-2370
Mailing address:
  • Phone: 410-944-8805
  • Fax: 410-944-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00528
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: