Provider Demographics
NPI:1922520063
Name:MARYLAND FOOT & ANKLE RECONSTRUCTION GROUP LLC
Entity Type:Organization
Organization Name:MARYLAND FOOT & ANKLE RECONSTRUCTION GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:NAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOUGHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:571-830-7983
Mailing Address - Street 1:14301 AUTUMN GOLD RD
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4208
Mailing Address - Country:US
Mailing Address - Phone:571-830-7983
Mailing Address - Fax:
Practice Address - Street 1:14301 AUTUMN GOLD RD
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-4208
Practice Address - Country:US
Practice Address - Phone:571-830-7983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty