Provider Demographics
NPI:1477688364
Name:ATLANTIC FOOT AND ANKLE GROUP INC
Entity Type:Organization
Organization Name:ATLANTIC FOOT AND ANKLE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-821-8639
Mailing Address - Street 1:PO BOX 1278
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-6278
Mailing Address - Country:US
Mailing Address - Phone:410-583-9206
Mailing Address - Fax:410-821-8639
Practice Address - Street 1:1205 YORK RD
Practice Address - Street 2:SUITE 17
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6210
Practice Address - Country:US
Practice Address - Phone:410-583-9206
Practice Address - Fax:410-821-8639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0976180001Medicare NSC