Provider Demographics
NPI:1093124778
Name:FREDERICK FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:FREDERICK FOOT AND ANKLE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YENISEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-668-9707
Mailing Address - Street 1:141 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-668-9707
Mailing Address - Fax:301-668-4927
Practice Address - Street 1:141 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 170
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-668-9707
Practice Address - Fax:301-668-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD413382000Medicaid
MD4291400001Medicare PIN