Provider Demographics
NPI:1528170594
Name:DR. DUANE A. MCKINNEY, LLC
Entity type:Organization
Organization Name:DR. DUANE A. MCKINNEY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-262-6314
Mailing Address - Street 1:7708 HANOVER PKWY
Mailing Address - Street 2:# 201
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2633
Mailing Address - Country:US
Mailing Address - Phone:301-262-6314
Mailing Address - Fax:301-262-6486
Practice Address - Street 1:7404 EXECUTIVE PL
Practice Address - Street 2:SUITE 501
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2268
Practice Address - Country:US
Practice Address - Phone:301-262-6314
Practice Address - Fax:301-262-6486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01331213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU85108Medicare UPIN