=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821083916
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IRA MICHAEL DEMING D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2005
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 CONGRESSIONAL LN #312
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-816-8681
-----------------------------------------------------
Fax | 301-816-8684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 121 CONGRESSIONAL LN #312
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-1542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-816-8681
-----------------------------------------------------
Fax | 301-816-8684
-----------------------------------------------------
=====================================================
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 | 00914
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------