Provider Demographics
NPI: | 1790367167 |
---|---|
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: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | TRITTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 301-933-7133 |
Mailing Address - Street 1: | PO BOX 844572 |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02284-4572 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-933-7133 |
Mailing Address - Fax: | 301-933-7137 |
Practice Address - Street 1: | 20905 PROFESSIONAL PLZ STE 310 |
Practice Address - Street 2: | |
Practice Address - City: | ASHBURN |
Practice Address - State: | VA |
Practice Address - Zip Code: | 20147-3409 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-723-9267 |
Practice Address - Fax: | 866-453-6775 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-04-26 |
Last Update Date: | 2021-04-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Single Specialty |