Provider Demographics
NPI:1003420225
Name:FOOT AND ANKLE PAIN CENTER LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ELGAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-575-3668
Mailing Address - Street 1:9821 BROKEN LAND PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1161
Mailing Address - Country:US
Mailing Address - Phone:410-575-3668
Mailing Address - Fax:
Practice Address - Street 1:9821 BROKEN LAND PKWY STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1161
Practice Address - Country:US
Practice Address - Phone:410-575-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty