MEDICARE: FREE STATE PODIATRY

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1518644061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREE STATE PODIATRY

Provider Business Mailing Address
First Line	:	PO BOX 2850
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-0850
Country	:	US
Telephone Number	:	202-258-4692
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 POST OFFICE RD STE 304
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3704
Country	:	US
Telephone Number	:	202-258-4692
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JUSTIN POINTER
Credential	:	PDM
Telephone Number	:	202-258-4692

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	09/04/2023

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Directions to “FREE STATE PODIATRY ” Practice Location

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