Provider Demographics
NPI:1548643646
Name:MICHAEL S. PRESTI DPM, PA
Entity type:Organization
Organization Name:MICHAEL S. PRESTI DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PRESTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-939-0055
Mailing Address - Street 1:131 S UNION AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3125
Mailing Address - Country:US
Mailing Address - Phone:410-939-0055
Mailing Address - Fax:410-939-0093
Practice Address - Street 1:327 CURTIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-939-0055
Practice Address - Fax:410-939-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01342213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD365421401Medicaid