Basic Information
| Provider Information | |||||||||
| NPI: | 1033684675 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 E GUDE DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4730 PUDDLEDOCK RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238751274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043203668 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2018 | ||||||||
| LastUpdateDate: | 10/10/2018 | ||||||||
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| AuthorizedOfficialLastName: | FREEDMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3015980130 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.