Provider Demographics
NPI:1538178603
Name:DRS HERTZ AND IDOL DPM, PA
Entity type:Organization
Organization Name:DRS HERTZ AND IDOL DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-934-3345
Mailing Address - Street 1:PO BOX 59714
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20859-9714
Mailing Address - Country:US
Mailing Address - Phone:301-934-3345
Mailing Address - Fax:301-934-3345
Practice Address - Street 1:515 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LAPLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-1320
Practice Address - Country:US
Practice Address - Phone:301-934-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
MD00403213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD602128000Medicaid
MD853LMedicare PIN
MD602128000Medicaid