Healthcare Provider Details

I. General information

NPI: 1114714417
Provider Name (Legal Business Name): FREDERICK FOOT AND ANKLE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19801 OBSERVATION DR
GERMANTOWN MD
20876-4070
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

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