Provider Demographics
NPI:1750727350
Name:RENAISSANCE FOOT & ANKLE CENTER
Entity type:Organization
Organization Name:RENAISSANCE FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-441-2655
Mailing Address - Street 1:7223 HANOVER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2023
Mailing Address - Country:US
Mailing Address - Phone:301-441-2655
Mailing Address - Fax:301-441-2656
Practice Address - Street 1:7223 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2023
Practice Address - Country:US
Practice Address - Phone:301-441-2655
Practice Address - Fax:301-441-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01387332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies