Provider Demographics
NPI:1023272226
Name:SANDTOWN FOOT & ANKLE CENTER LLC
Entity type:Organization
Organization Name:SANDTOWN FOOT & ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIC
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-523-5898
Mailing Address - Street 1:911 N CAREY ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-2550
Mailing Address - Country:US
Mailing Address - Phone:410-523-5898
Mailing Address - Fax:410-523-5815
Practice Address - Street 1:911 N CAREY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2550
Practice Address - Country:US
Practice Address - Phone:410-523-5898
Practice Address - Fax:410-523-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403809600Medicaid
MDU50262Medicare UPIN