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General NPI Number Information
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NPI Number | 1518644061
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Entity Type | Organization
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Legal Business Name | FREE STATE PODIATRY
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 09/04/2023
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Provider Practice Location Address
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Address Line | 50 POST OFFICE RD STE 304
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City | WALDORF
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State | MD
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Zip | 20602-3704
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Country | US
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Telephone | 202-258-4692
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2850
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City | SPRINGFIELD
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State | VA
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Zip | 22152-0850
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Country | US
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Telephone | 202-258-4692
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN POINTER
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Credential | PDM
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Telephone | 202-258-4692
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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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