Provider Demographics
NPI:1740302256
Name:LAUREL FOOT AND ANKLE CENTER, LLC
Entity type:Organization
Organization Name:LAUREL FOOT AND ANKLE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-953-3668
Mailing Address - Street 1:14440 CHERRY LANE CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4946
Mailing Address - Country:US
Mailing Address - Phone:301-953-3668
Mailing Address - Fax:301-953-3854
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:SUITE 104
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-953-3668
Practice Address - Fax:301-953-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01192213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB810OtherBLUE CROSS BLUE SHIELD
MDLR52LAOtherBLUE CROSS BLUE SHIELD
MDLR52LAOtherBLUE CROSS BLUE SHIELD
MD0869340001Medicare NSC