Provider Demographics
NPI:1558326298
Name:FAMILY FOOT & ANKLE ASSOCIATES OF MARYLAND, P.A.
Entity Type:Organization
Organization Name:FAMILY FOOT & ANKLE ASSOCIATES OF MARYLAND, P.A.
Other - Org Name:DRS. ALVIN D. GROMAN AND NORMAN D. RUBIN, DPM,PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-924-5044
Mailing Address - Street 1:3408 OLANDWOOD CT
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1367
Mailing Address - Country:US
Mailing Address - Phone:301-924-5044
Mailing Address - Fax:301-924-5933
Practice Address - Street 1:3408 OLANDWOOD CT
Practice Address - Street 2:SUITE 204
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1367
Practice Address - Country:US
Practice Address - Phone:301-924-5044
Practice Address - Fax:301-924-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0334120001Medicare NSC
MDP00160078Medicare PIN
MD410205Medicare PIN
MD410205Medicare PIN