Provider Demographics
NPI:1245597616
Name:FOOT & ANKLE CENTER OF MARYLAND, LLC
Entity Type:Organization
Organization Name:FOOT & ANKLE CENTER OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-761-3501
Mailing Address - Street 1:808 LANDMARK DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4983
Mailing Address - Country:US
Mailing Address - Phone:410-761-3501
Mailing Address - Fax:410-761-3505
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:SUITE 225
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-761-3501
Practice Address - Fax:410-761-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01203213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD241975Medicare PIN