Basic Information
| Provider Information | |||||||||
| NPI: | 1689040958 | ||||||||
| 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 | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208501341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019337133 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2021 K ST NW | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200061003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2022234616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 11/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | FREEDMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3015980130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.