Basic Information
| Provider Information | |||||||||
| NPI: | 1447832811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 844572 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022844572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109337133 | ||||||||
| FaxNumber: | 3019337137 | ||||||||
| Practice Location | |||||||||
| Address1: | 9918 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220313901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032739818 | ||||||||
| FaxNumber: | 8664536775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2021 | ||||||||
| LastUpdateDate: | 04/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | TRITTO | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3019337133 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 04/26/2021 | ||||||||
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.