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?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty