Provider Demographics
NPI:1174616585
Name:METROPOLITIAN PODIATRY ASSOC PLLC
Entity type:Organization
Organization Name:METROPOLITIAN PODIATRY ASSOC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:BERTHIE
Authorized Official - Last Name:LABISSIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:202-882-9682
Mailing Address - Street 1:7603 GEORGIA AVE NW STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1630
Mailing Address - Country:US
Mailing Address - Phone:202-882-9682
Mailing Address - Fax:202-882-4983
Practice Address - Street 1:7603 GEORGIA AVE NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1630
Practice Address - Country:US
Practice Address - Phone:202-882-9682
Practice Address - Fax:202-882-4983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO582213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC027002300Medicaid
DCG00287Medicare PIN