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NPI Code Detail

MEDICARE: PETERS PODIATRY GROUP PLLC

MEDICARE: PETERS PODIATRY GROUP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist01475MD

General Provider Information

NPI Number : 1255639779
Entity Type Code : Organization
Provider Name (Legal Business Name) : PETERS PODIATRY GROUP PLLC
Provider Business Mailing Address
First Line : 1008 HAMLIN ST NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20017-3422
Country : US
Telephone Number : 202-270-0388
Fax Number :
Provider Business Practice Location Address
First Line : 1 EASTERN BLVD
Second Line :
City : ESSEX
State : MD
Zip : 21221-7016
Country : US
Telephone Number : 202-270-0388
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. LENNIE M. PETERS
Credential : D.P.M.
Telephone Number : 718-972-5000
Provider Enumeration Date : 03/08/2011
Last Update Date : 03/08/2011

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