Organization
FOOT CARE CENTER OF COLLEGE PARK, CHARTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MARC JACOBS D.P.M. (OWNER/PRESIDENT)
(301) 779-0355
Entity
Organization
Contact information
Practice address
4511 KNOX RD, SUITE 103, COLLEGE PARK, MD 20740-3380
(301) 779-0355
(301) 927-7036
Mailing address
4511 KNOX RD, SUITE 103, COLLEGE PARK, MD 20740-3380
(301) 779-0355
(301) 927-7036
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
952
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9948
BC
—
01
—
T261FO
BCBS MD
—
Enumeration date
11/04/2006
Last updated
12/07/2007
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