Healthcare Provider Details

I. General information

NPI: 1538178603
Provider Name (Legal Business Name): DRS HERTZ AND IDOL DPM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2006
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CHARLES ST
LAPLATA MD
20646-1320
US

IV. Provider business mailing address

PO BOX 59714
POTOMAC MD
20859-9714
US

V. Phone/Fax

Practice location:
  • Phone: 301-934-3345
  • Fax:
Mailing address:
  • Phone: 301-934-3345
  • Fax: 301-934-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00403
License Number StateMD

VIII. Authorized Official

Name: JOEL S HERTZ
Title or Position: PARTNER
Credential: D.P.M.
Phone: 301-934-3345