Provider Demographics
NPI:1316347800
Name:FOOTER OBSTETRICS & GYNECOLOGY GROUP, LLC
Entity type:Organization
Organization Name:FOOTER OBSTETRICS & GYNECOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-215-7778
Mailing Address - Street 1:4808 MOORLAND LN
Mailing Address - Street 2:SUITE #103
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-6110
Mailing Address - Country:US
Mailing Address - Phone:301-215-7778
Mailing Address - Fax:301-215-4561
Practice Address - Street 1:4808 MOORLAND LN
Practice Address - Street 2:SUITE #103
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-6110
Practice Address - Country:US
Practice Address - Phone:301-215-7778
Practice Address - Fax:301-215-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC89257Medicare UPIN