=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447710124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN FURMANEK DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2019
-----------------------------------------------------
Last Update Date | 12/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9105 FRANKLIN SQUARE DR STE 214
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21237-3934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-777-7631
-----------------------------------------------------
Fax | 443-777-8667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9105 FRANKLIN SQUARE DR STE 214
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21237-3934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-777-7631
-----------------------------------------------------
Fax | 443-777-8667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO4437
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 01770
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------