Healthcare Provider Details

I. General information

NPI: 1659741742
Provider Name (Legal Business Name): LANSDOWNE PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44135 WOODRIDGE PKWY SUITE 180
LEESBURG VA
20176-1244
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 571-223-0424
  • Fax: 571-223-0425
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MONIQUE RENEE ROLLE
Title or Position: OWNER
Credential: D.P.M.
Phone: 571-223-0424