MEDICARE: PODIATRY AFFILIATES, P.A.

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	213EP1101X	Primary Podiatric Medicine Podiatrist

General Provider Information

NPI Number	:	1871716860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY AFFILIATES, P.A.

Provider Business Mailing Address
First Line	:	1 N MAIN ST
Second Line	:
City	:	BEL AIR
State	:	MD
Zip	:	21014-3592
Country	:	US
Telephone Number	:	410-803-0788
Fax Number	:	410-803-1859

Provider Business Practice Location Address
First Line	:	700 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-2350
Country	:	US
Telephone Number	:	410-539-3362
Fax Number	:	410-752-3340

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STAN HOWARD BOOK
Credential	:	C.P.A.
Telephone Number	:	410-583-8898

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	10/22/2007

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