| Organization Name: | FOOT CARE CENTER OF COLLEGE PARK, CHARTERED |
| NPI Number: | 1043399439 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD MARC JACOBS (OWNER/PRESIDENT) |
| Mailing Address: | 4511 Knox Rd Suite 103 College Park |
| State: | MD US |
| Postal Code: | 207403380 |
| Phone Number: | 3017790355 |
| Fax Number: | 3019277036 |
| NPI Enumeration Date: | 11/04/2006 |
| NPI Last Update Date: | 12/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | 952 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |