Mark Anthony Boissonneault, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

01789 Issued in MD

Practice address

4 Glyndon Dr Ste 2a
Reisterstown, MD 21136-2002

Phone

(410) 833-2255

NPI assigned

Mar 24, 2020

Last updated

Aug 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

William M. Scholl College of Podiatric Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Podiatry of Maryland, LLCGroup PAC ID 4486650306, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Podiatry of Maryland, LLC

  • Podiatrist
  • Reisterstown, MD
  • NPI 1447285788
  Medicare reassignment Care Compare group NPD
• Carroll Footworks Surgery Center ,LLC

  dba Glyndon Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Reisterstown, MD
  • NPI 1124136437
  NPD (past)

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1508493248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GLYNDON DR STE 2A",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211362002",
            "telephone_number": "410-833-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 GLYNDON DR STE 2A",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211362002",
            "telephone_number": "410-833-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOISSONNEAULT",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MD",
            "license": "01789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billy K Blaylock III, CCMA OTC
• Sheryl Block
• Sharessa Boardley
• Elana Bodner
• Body Basics Wellness Center LLC
• William Anthony Bolesta, BOC
• Rebecca Bolton, LCPC
• Barbara Ann Borcik, MS, RD, LD, CDE
• Dawn Rae Bottorff, LCSW-C
• Lisa Ann Bowerman, PHARMD, RPH

• Podiatrist in Reisterstown, MD
• Providers in Reisterstown, MD by specialty
• Podiatrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.