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General NPI Number Information
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NPI Number | 1972501906
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Entity Type | Individual
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Provider Name | JOSEPH GERARD PROEBSTLE D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 8023 RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-7107
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Country | US
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Telephone | 410-761-3338
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Fax | 410-761-0265
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Provider Business Mailing Address
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Address Line | 8023 RITCHIE HWY
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City | PASADENA
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State | MD
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Zip | 21122-7107
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Country | US
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Telephone | 410-761-3338
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Fax | 410-761-0265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 01059
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License Number State | MD
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