Provider Demographics
NPI:1114198801
Name:FAMILY FOOT & ANKLE ASSOCIATES OF MARYLAND, PA
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE ASSOCIATES OF MARYLAND, PA
Other - Org Name:GROMAN & RUBIN DPM, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-924-5044
Mailing Address - Street 1:3408 OLANDWOOD CT STE 204
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1367
Mailing Address - Country:US
Mailing Address - Phone:301-924-5044
Mailing Address - Fax:301-924-5933
Practice Address - Street 1:5801 ALLENTOWN RD STE 305
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4553
Practice Address - Country:US
Practice Address - Phone:301-868-7670
Practice Address - Fax:301-868-4362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY FOOT & ANKLE ASSOCIATES OF MARYLAND, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-20
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00160078Medicare PIN
MD410205Medicare PIN
MD0334120002Medicare NSC
MD0334120002Medicare NSC