Basic Information
| Provider Information | |||||||||
| NPI: | 1003812124 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY FOOT AND ANKLE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2730 UNIVERSITY BLVD W | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019493668 | ||||||||
| FaxNumber: | 3019498833 | ||||||||
| Practice Location | |||||||||
| Address1: | 2730 UNIVERSITY BLVD W | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019493668 | ||||||||
| FaxNumber: | 3019498833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | SPECTOR | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3015898886 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 01072 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | CH2860 | 01 | RAILROAD MEDICARE | OTHER |