Provider Demographics
NPI:1942582655
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:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-598-0130
Mailing Address - Street 1:1600 E GUDE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1496
Mailing Address - Country:US
Mailing Address - Phone:301-933-7133
Mailing Address - Fax:301-933-7137
Practice Address - Street 1:1600 E GUDE DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1496
Practice Address - Country:US
Practice Address - Phone:301-933-7133
Practice Address - Fax:301-933-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6612640001Medicare NSC