Provider Demographics
NPI:1780871723
Name:FOOT & ANKLE LLC
Entity type:Organization
Organization Name:FOOT & ANKLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-251-6226
Mailing Address - Street 1:932 HUNGERFORD DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1713
Mailing Address - Country:US
Mailing Address - Phone:301-251-6226
Mailing Address - Fax:301-315-8273
Practice Address - Street 1:932 HUNGERFORD DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1713
Practice Address - Country:US
Practice Address - Phone:301-251-6226
Practice Address - Fax:301-315-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01422213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1174515589OtherNPI