Healthcare Provider Details

I. General information

NPI: 1700899192
Provider Name (Legal Business Name): CHESAPEAKE FAMILY FOOT CARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 DUTCHMANS LN SUITE C
EASTON MD
21601
US

IV. Provider business mailing address

PO BOX 705
EASTON MD
21601-8912
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-0991
  • Fax: 410-822-0577
Mailing address:
  • Phone: 410-822-0991
  • Fax: 410-822-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSE DEBORJA
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 410-822-0991