Healthcare Provider Details

I. General information

NPI: 1164427704
Provider Name (Legal Business Name): JANICE POSTAL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 ROCKVILLE PIKE STE 203
ROCKVILLE MD
20852-3142
US

IV. Provider business mailing address

11125 ROCKVILLE PIKE STE 203
ROCKVILLE MD
20852-3142
US

V. Phone/Fax

Practice location:
  • Phone: 301-681-6008
  • Fax: 301-681-8908
Mailing address:
  • Phone: 301-681-6008
  • Fax: 301-681-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number960
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number960
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: