Healthcare Provider Details

I. General information

NPI: 1023267903
Provider Name (Legal Business Name): FAMILY PODIATRY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 ANNAPOLIS RD STE 12
BLADENSBURG MD
20710-2213
US

IV. Provider business mailing address

615 QUACKENBOS ST NW
WASHINGTON DC
20011-1229
US

V. Phone/Fax

Practice location:
  • Phone: 301-390-4440
  • Fax: 202-726-0656
Mailing address:
  • Phone: 301-390-4440
  • Fax: 202-726-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number103000906
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberPO517
License Number StateDC
# 4
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number01129
License Number StateMD

VIII. Authorized Official

Name: TERESA L HILLIARD
Title or Position: OWNER
Credential: DPM
Phone: 301-390-4440