Basic Information
| Provider Information | |||||||||
| NPI: | 1679566228 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBULATORY FOOT AND ANKLE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 INTERNATIONAL DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209061550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015980130 | ||||||||
| FaxNumber: | 3015985091 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 INTERNATIONAL DR | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209061550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3015980130 | ||||||||
| FaxNumber: | 3015985091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | FREEDMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3015980130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A1260 | MD | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 130204300 | 05 | MD | MEDICAID |