Healthcare Provider Details

I. General information

NPI: 1497282149
Provider Name (Legal Business Name): LANSDOWNE PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

IV. Provider business mailing address

44135 WOODRIDGE PKWY SUITE180
LEESBURG VA
20176-8282
US

V. Phone/Fax

Practice location:
  • Phone: 410-335-0008
  • Fax:
Mailing address:
  • Phone: 571-223-0424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MONIQUE R ROLLE
Title or Position: OWNER/MEDICAL DOCTOR
Credential: D.P.M.
Phone: 571-223-0424