Provider Demographics
NPI:1285009738
Name:CAMBRIDGE FOOT & ANKLE CENTER
Entity Type:Organization
Organization Name:CAMBRIDGE FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEMENA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:443-225-6640
Mailing Address - Street 1:100 BRAMBLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 BRAMBLE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2471
Practice Address - Country:US
Practice Address - Phone:443-225-6640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01443332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4236271-00Medicaid