Provider Demographics
NPI:1477791242
Name:DESSELB FOOT & ANKLE CENTER
Entity Type:Organization
Organization Name:DESSELB FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:SARTEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:240-425-2407
Mailing Address - Street 1:14501 ANSTED RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4412
Mailing Address - Country:US
Mailing Address - Phone:301-384-0447
Mailing Address - Fax:
Practice Address - Street 1:13823 OUTLET DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4971
Practice Address - Country:US
Practice Address - Phone:301-890-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-31
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01468213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD163623Medicare PIN
MD165073Medicare PIN
MD136406ZERJMedicare PIN
MD136406ZEW8Medicare PIN