Healthcare Provider Details

I. General information

NPI: 1144221375
Provider Name (Legal Business Name): WHITE MARSH FOOT & ANKLE SURGERY CENTER L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SANDPIPER CIR SUITE 104
NOTTINGHAM MD
21236-4991
US

IV. Provider business mailing address

8100 SANDPIPER CIR SUITE 104
NOTTINGHAM MD
21236-4991
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-3300
  • Fax: 410-933-3303
Mailing address:
  • Phone: 410-933-3300
  • Fax: 410-933-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1393
License Number StateMD

VIII. Authorized Official

Name: DR. JAMES STEVEN ADLEBERG
Title or Position: CORPORATE OFFICER
Credential: DPM
Phone: 410-933-3300