Foot Care Center of College Park, Chartered

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

952 Issued in MD

Legal business name

FOOT CARE CENTER OF COLLEGE PARK, CHARTERED

Practice address

4511 Knox Rd
Suite 103
College Park, MD 20740-3380

Phone

(301) 779-0355

Fax

(301) 927-7036

NPI assigned

Nov 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Richard Marc Jacobs, D.P.M.

Title

Owner/President

Phone

(301) 779-0355

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1043399439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 KNOX RD",
            "address_2": "SUITE 103",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403380",
            "telephone_number": "301-779-0355",
            "fax_number": "301-927-7036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 KNOX RD",
            "address_2": "SUITE 103",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207403380",
            "telephone_number": "301-779-0355",
            "fax_number": "301-927-7036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOT CARE CENTER OF COLLEGE PARK, CHARTERED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-04",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "MARC",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "301-779-0355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "MD",
            "license": "952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "9948",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MD",
            "identifier": "T261FO",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Donna Parker Fleshman, PA
• Mathias Kedju Foasung Zah
• Eric Parfait Folenou
• Nelson N Fondungalla
• Cletus Ntungwen Fongoh
• Agnes Ngwuimaka Forbah
• Amy Foster, LCSW-C
• Stephanie Foster
• Frances Korbly-Canter, R.Ac.PC
• Shiri Julienne Fru

• Podiatric Clinic/Center in College Park, MD
• Providers in College Park, MD by specialty
• Podiatric Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.