Provider Demographics
NPI:1346861614
Name:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-933-7133
Mailing Address - Street 1:PO BOX 844572
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-4572
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1506 E FRANKLIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2825
Practice Address - Country:US
Practice Address - Phone:919-960-8858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty