Healthcare Provider Details

I. General information

NPI: 1548685258
Provider Name (Legal Business Name): HEALTHDRIVE PODIATRY GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2014
Last Update Date: 11/01/2020
Certification Date: 11/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ALEXANDER BELL DR SUITE 200
COLUMBIA MD
21046-2122
US

IV. Provider business mailing address

100 CROSSING BLVD SUITE 300
FRAMINGHAM MA
01702-5555
US

V. Phone/Fax

Practice location:
  • Phone: 888-964-6681
  • Fax: 888-662-0859
Mailing address:
  • Phone: 617-964-6681
  • Fax: 339-686-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SHADI ADIB ABBOUD
Title or Position: TREASURER/PRACTICE DIRECTOR
Credential: DPM
Phone: 857-255-0486