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General NPI Number Information
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NPI Number | 1386837581
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Entity Type | Organization
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Legal Business Name | CHARM CITY PODIATRY, LLC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 7505 OSLER DR SUITE 307
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City | TOWSON
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State | MD
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Zip | 21204-7736
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Country | US
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Telephone | 410-828-7200
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Fax | 410-828-7201
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Provider Business Mailing Address
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Address Line | 7505 OSLER DR SUITE 307
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City | TOWSON
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State | MD
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Zip | 21204-7736
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Country | US
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Telephone | 410-828-7200
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Fax | 410-828-7201
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Authorized Official
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Title or Position | PODIATRIST/OWNER
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Name | DR. TINA MARIE WOODBURN
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Credential | D.P.M.
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Telephone | 410-828-7200
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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 | 01343
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License Number State | MD
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