Healthcare Provider Details

I. General information

NPI: 1508019126
Provider Name (Legal Business Name): WALBROOK FOOT AND ANKLE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 GARRISON BLVD SUITE 203
BALTIMORE MD
21216-2619
US

IV. Provider business mailing address

2200 GARRISON BLVD SUITE 203
BALTIMORE MD
21216-2619
US

V. Phone/Fax

Practice location:
  • Phone: 410-945-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENISE BEACH
Title or Position: OWNER
Credential: DPM
Phone: 410-945-5400