Healthcare Provider Details

I. General information

NPI: 1649465261
Provider Name (Legal Business Name): MARKHAM FOOT &ANKLE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 ANNAPOLIS RD SUITE 104
ODENTON MD
21113-1344
US

IV. Provider business mailing address

1215 ANNAPOLIS ROAD SUITE 104
ODENTON MD
21113
US

V. Phone/Fax

Practice location:
  • Phone: 410-672-0464
  • Fax: 410-551-4710
Mailing address:
  • Phone: 410-672-0464
  • Fax: 410-551-4710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01399
License Number StateMD

VIII. Authorized Official

Name: DR. CHARLES FRANK MARKHAM
Title or Position: OWNER
Credential: D.P.M.
Phone: 410-672-0464