person
Dr. Jay Marc Mickenberg, DPM
Podiatrist in Pasadena, Maryland
NPI 1336149962

Jay Marc Mickenberg is a Podiatrist based in Pasadena, MD. Jay Marc Mickenberg practices in Pasadena, MD and has the professional credentials of DPM. The NPI Number for Jay Marc Mickenberg is 1336149962 and holds a License No. 1053 (Maryland).

The current practice location address for Jay Marc Mickenberg is 8094 Edwin Raynor Blvd, Pasadena, MD and can be reached out via phone at 410-255-0040 and via fax at 410-360-4955.

Location: 8094 Edwin Raynor Blvd, Pasadena, MD, 21122-6834
person
Provider Profile Details
NPI Number
1336149962
Provider Name
Jay Marc Mickenberg
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
8094 Edwin Raynor Blvd, Pasadena, MD, 21122-6834
Phone Number
410-255-0040
Fax Number
410-360-4955
Provider Enumeration Date
07/26/2005
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
T276 01 MD BC/BS OF MD
062308301 05 MD
521617469 01 UNITED HEALTHCARE
B765 001 01 BC/BS FEDERAL
1338463 01 CIGNA PPO/HMO
521617469 01 EMPLOYER HEALTH INSURANCE
521617469 01 COVENTRY
521617469 01 FIRST HEALTH
521617469 01 MAMSI
521617469 01 TRICARE
217484 01 ALLIANCE
521617469 01 EHP
B765 01 MD BLUE CHOICE
217484 01 MDIPA/OPTIMUM CHOICE
480012800 01 RAILROAD MEDICARE
521617469 01 CIGNA HEALTHCARE OPEN ACC
521617469 01 FIDELITY
institution
Provider Business Practice Location Address Details
Address
8094 Edwin Raynor Blvd
City
State
Zip
21122-6834
Phone Number
410-255-0040
Fax Number
410-360-4955
person
Provider Business Mailing Address Details
Address
8094 Edwin Raynor Blvd
City
State
Zip
21122-6834
Phone Number
410-255-0040
Fax Number
410-360-4955
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
-
Taxonomy
License No.
1053 (Maryland)
Definition
A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy.
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