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General NPI Number Information
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NPI Number | 1902270820
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Entity Type | Organization
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Legal Business Name | FAMILY FOOT CLINIC OF GREATER BALTIMORE
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 1 VILLAGE SQ SUITE 165
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City | BALTIMORE
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State | MD
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Zip | 21210-1602
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Country | US
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Telephone | 410-878-1340
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Fax |
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Provider Business Mailing Address
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Address Line | 1 VILLAGE SQ SUITE 165
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City | BALTIMORE
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State | MD
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Zip | 21210-1602
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Country | US
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Telephone | 410-878-1340
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | DR. MICHAEL ROBERT SMITH JR.
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Credential | DPM
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Telephone | 410-878-1340
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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 | 01466
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License Number State | MD
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