Individual
DR. ANDREW JAY LANDIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4136 E JOPPA RD, SUITE L, NOTTINGHAM, MD 21236-2286
(410) 256-1188
(410) 256-1188
Mailing address
PO BOX 371, FOOT CENTER OF PERRY HALL, PERRY HALL, MD 21128-0371
(410) 256-1188
(410) 256-1188
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00890
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37024811 00
—
MD
01
—
39842201
BCBS NASCO
MH
01
—
R5690001
FEDERAL BCBS
MD
Enumeration date
06/09/2006
Last updated
07/08/2007
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