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General NPI Number Information
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NPI Number | 1558852988
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Entity Type | Organization
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Legal Business Name | DMV FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 15480 ANNAPOLIS RD STE 202-437
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City | BOWIE
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State | MD
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Zip | 20715
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Country | US
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Telephone | 347-560-3338
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Fax |
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Provider Business Mailing Address
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Address Line | 151 WESTWAY APT 203
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City | GREENBELT
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State | MD
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Zip | 20770-1980
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | STACIA N JONES
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Credential | DPM
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Telephone | 347-560-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 01594
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License Number State | MD
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