Provider Demographics
NPI:1225164874
Name:FAMILY FOOT CARE CENTER LLC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MADDEN YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-645-1406
Mailing Address - Street 1:4475 REGENCY PL
Mailing Address - Street 2:STE 204
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3074
Mailing Address - Country:US
Mailing Address - Phone:301-645-1406
Mailing Address - Fax:301-645-0997
Practice Address - Street 1:4475 REGENCY PL
Practice Address - Street 2:STE 204
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3074
Practice Address - Country:US
Practice Address - Phone:301-645-1406
Practice Address - Fax:301-645-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5790290001Medicare NSC
MD116NMedicare PIN