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General NPI Number Information
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NPI Number | 1043057508
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Entity Type | Organization
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Legal Business Name | FOOT CENTERS OF MARYLAND, LLC
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Dates
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Enumeration Date | 07/11/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 7927 RITCHIE HWY STE D
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City | GLEN BURNIE
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State | MD
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Zip | 21061-4373
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Country | US
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Telephone | 410-661-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 6030 MARSHALEE DR STE 212
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City | ELKRIDGE
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State | MD
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Zip | 21075-5987
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Country | US
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Telephone | 410-661-3338
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SEAN SIDER
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Credential | DPM
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Telephone | 410-661-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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