Healthcare Provider Details

I. General information

NPI: 1205906302
Provider Name (Legal Business Name): FREDERICK FOOT AND ANKLE SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR SUITE 170
FREDERICK MD
21702-4530
US

IV. Provider business mailing address

141 THOMAS JOHNSON DR. SUITE 141
FREDERICK MD
21702-4530
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9707
  • Fax: 301-668-4927
Mailing address:
  • Phone: 301-668-9707
  • Fax: 301-668-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01292
License Number StateMD

VIII. Authorized Official

Name: DR. YENISEY YANES
Title or Position: OWNER
Credential: DPM
Phone: 301-668-9707