Provider Demographics
NPI:1760660641
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:CHASE PARKWAY PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:DPM/OWNER
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 1:714 CHASE PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3012
Mailing Address - Country:US
Mailing Address - Phone:203-755-0489
Mailing Address - Fax:203-755-7523
Practice Address - Street 1:714 CHASE PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3012
Practice Address - Country:US
Practice Address - Phone:203-755-0489
Practice Address - Fax:203-755-7523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT548332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0458340001Medicare NSC