Healthcare Provider Details

I. General information

NPI: 1881697886
Provider Name (Legal Business Name): FRANKLIN RANDALL POLUN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date: 03/16/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

12400 PARK POTOMAC AVE # R2
POTOMAC MD
20854-6973
US

IV. Provider business mailing address

12400 PARK POTOMAC AVE # R2
POTOMAC MD
20854-6973
US

V. Phone/Fax

Practice location:
  • Phone: 301-983-8202
  • Fax: 301-299-3985
Mailing address:
  • Phone: 301-983-8202
  • Fax: 877-810-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00941
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: