Provider Demographics
NPI:1144221375
Name:WHITE MARSH FOOT & ANKLE SURGERY CENTER L.L.C.
Entity Type:Organization
Organization Name:WHITE MARSH FOOT & ANKLE SURGERY CENTER L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ADLEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-933-3300
Mailing Address - Street 1:8100 SANDPIPER CIR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4991
Mailing Address - Country:US
Mailing Address - Phone:410-933-3300
Mailing Address - Fax:410-933-3303
Practice Address - Street 1:8100 SANDPIPER CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4991
Practice Address - Country:US
Practice Address - Phone:410-933-3300
Practice Address - Fax:410-933-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1393261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD177ZMedicare ID - Type Unspecified
MD177ZMedicare PIN