Provider Demographics
NPI:1902220627
Name:FREDERICK FOOT & ANKLE ASC LLC
Entity Type:Organization
Organization Name:FREDERICK FOOT & ANKLE ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YENISEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YANES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-668-9707
Mailing Address - Street 1:PO BOX 826995
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:141 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 170
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4502
Practice Address - Country:US
Practice Address - Phone:301-668-9707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical