Provider Demographics
NPI:1003812124
Name:MONTGOMERY FOOT AND ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:MONTGOMERY FOOT AND ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SPECTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-589-8886
Mailing Address - Street 1:2730 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1905
Mailing Address - Country:US
Mailing Address - Phone:301-949-3668
Mailing Address - Fax:301-949-8833
Practice Address - Street 1:2730 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 1000
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-1905
Practice Address - Country:US
Practice Address - Phone:301-949-3668
Practice Address - Fax:301-949-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01072213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH2860OtherRAILROAD MEDICARE
CH2860OtherRAILROAD MEDICARE
DC4384340001Medicare NSC