Healthcare Provider Details

I. General information

NPI: 1114256062
Provider Name (Legal Business Name): MARYLAND FOOT & ANKLE RESTORATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2009
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 BELCREST RD STE 1
HYATTSVILLE MD
20782-2011
US

IV. Provider business mailing address

PO BOX 83849
GAITHERSBURG MD
20883-3849
US

V. Phone/Fax

Practice location:
  • Phone: 301-699-5900
  • Fax: 301-699-9297
Mailing address:
  • Phone: 301-699-5900
  • Fax: 301-699-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01450
License Number StateMD

VIII. Authorized Official

Name: DR. JOHNY JAMAL MOTRAN
Title or Position: PODIATRIC SURGEON
Credential: D.P.M.
Phone: 301-699-5900