Healthcare Provider Details

I. General information

NPI: 1275703696
Provider Name (Legal Business Name): WAYNE K KNOLL, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COX RD
HUNTINGTOWN MD
20639-9278
US

IV. Provider business mailing address

32 COX RD
HUNTINGTOWN MD
20639-9278
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8223
  • Fax: 410-535-0802
Mailing address:
  • Phone: 410-266-8223
  • Fax: 410-535-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01252
License Number StateMD

VIII. Authorized Official

Name: DR. WAYNE K KNOLL JR.
Title or Position: OWNER
Credential: DPM
Phone: 410-266-8223