Provider Demographics
NPI:1669730537
Name:ELKTON FOOT AND ANKLE CENTER, PA
Entity type:Organization
Organization Name:ELKTON FOOT AND ANKLE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-398-6576
Mailing Address - Street 1:205 E MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5779
Mailing Address - Country:US
Mailing Address - Phone:410-398-6576
Mailing Address - Fax:410-398-8241
Practice Address - Street 1:205 E MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-398-6576
Practice Address - Fax:410-398-8241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01419213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty