Provider Demographics
NPI:1740060409
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:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-933-7133
Mailing Address - Street 1:199 E MONTGOMERY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2361
Mailing Address - Country:US
Mailing Address - Phone:301-911-7133
Mailing Address - Fax:
Practice Address - Street 1:3801 WAKE FOREST RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6864
Practice Address - Country:US
Practice Address - Phone:919-850-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site