Provider Demographics
NPI:1013198233
Name:EASTERN SHORE FOOT AND ANKLE
Entity Type:Organization
Organization Name:EASTERN SHORE FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-822-0645
Mailing Address - Street 1:8579 COMMERCE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7491
Mailing Address - Country:US
Mailing Address - Phone:410-822-0645
Mailing Address - Fax:410-763-8744
Practice Address - Street 1:8579 COMMERCE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7491
Practice Address - Country:US
Practice Address - Phone:410-822-0645
Practice Address - Fax:410-763-8744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3443070001Medicare NSC
MD521LMedicare PIN