Healthcare Provider Details

I. General information

NPI: 1659377166
Provider Name (Legal Business Name): FOOT SURGI-CENTER OF OWINGS MILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CROSSROADS DR STE 410
OWINGS MILLS MD
21117-5439
US

IV. Provider business mailing address

25 CROSSROADS DR STE 410
OWINGS MILLS MD
21117-5439
US

V. Phone/Fax

Practice location:
  • Phone: 410-363-2233
  • Fax: 410-363-2235
Mailing address:
  • Phone: 410-363-2233
  • Fax: 410-363-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA1397
License Number StateMD

VIII. Authorized Official

Name: DR. ERIC L DIAMOND
Title or Position: OWNER
Credential: DPM
Phone: 410-363-2233