Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 01136 | MD |
Y | 222Z00000X | Podiatrist | 01136 | MD |
N | 213ES0103X | Foot & Ankle Surgery | 01136 | MD |
NPI | 1083766067 |
---|---|
Provider Name | Dr. Sheriar Foolad Demehri |
First Address | Leonardtown, MD 20650 |
Second Address | Leonardtown, MD 20650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 13/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190728000 | (05) | MD |
B5510001 | BCBS MD (01) | |
U35357 | (02) |