Healthcare Provider Details

I. General information

NPI: 1386147411
Provider Name (Legal Business Name): NATIONAL CAPITAL FOOT AND ANKLE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 WISCONSIN AVE NW STE 522
WASHINGTON DC
20016-4131
US

IV. Provider business mailing address

12400 PARK POTOMAC AVE STE R2
POTOMAC MD
20854-7024
US

V. Phone/Fax

Practice location:
  • Phone: 202-306-3733
  • Fax:
Mailing address:
  • Phone: 301-983-8202
  • Fax: 877-810-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANKLIN R POLUN
Title or Position: PRESIDENT/CEO
Credential: DPM
Phone: 301-983-8202