Healthcare Provider Details

I. General information

NPI: 1902220627
Provider Name (Legal Business Name): FREDERICK FOOT & ANKLE ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 THOMAS JOHNSON DR SUITE 170
FREDERICK MD
21702-4502
US

IV. Provider business mailing address

PO BOX 826995
PHILADELPHIA PA
19182-6995
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9707
  • 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: YENISEY YANES
Title or Position: MEMBER
Credential: DPM
Phone: 301-668-9707