Healthcare Provider Details

I. General information

NPI: 1669764114
Provider Name (Legal Business Name): FREDERICK FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR SUITE I
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

141 THOMAS JOHNSON DR STE 170
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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

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