Provider Demographics
NPI:1265462188
Name:THE BELTSVILLE FOOT AND ANKLE CENTER INC
Entity Type:Organization
Organization Name:THE BELTSVILLE FOOT AND ANKLE CENTER INC
Other - Org Name:JOHN S. FREID, DPM, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIBOLDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-937-5666
Mailing Address - Street 1:10720 BALTIMORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705
Mailing Address - Country:US
Mailing Address - Phone:301-937-5666
Mailing Address - Fax:301-937-0453
Practice Address - Street 1:10720 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2138
Practice Address - Country:US
Practice Address - Phone:301-937-5666
Practice Address - Fax:301-937-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9022007 00Medicaid
MD9022007 00Medicaid
MDG00695Medicare PIN