MEDICARE: WAXIMUS PODIATRY 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
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1538871819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAXIMUS PODIATRY PLLC

Provider Business Mailing Address
First Line	:	505 DARBY RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-4702
Country	:	US
Telephone Number	:	610-999-3397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 CEDAR CORNER RD STE A
Second Line	:
City	:	PERRYVILLE
State	:	MD
Zip	:	21903-2306
Country	:	US
Telephone Number	:	610-999-3397
Fax Number	:	610-227-2292

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW J WAXMAN
Credential	:	DPM
Telephone Number	:	610-999-3397

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	09/07/2023

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