Provider Demographics
NPI: | 1114569100 |
---|---|
Name: | FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC |
Entity Type: | Organization |
Organization Name: | FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PARTNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TRITTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 301-933-7133 |
Mailing Address - Street 1: | 1600 E GUDE DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROCKVILLE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20850-1496 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-933-7133 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10370 PARK RD STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28210-8509 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-542-8253 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-11 |
Last Update Date: | 2019-10-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |