Healthcare Provider Details

I. General information

NPI: 1124385505
Provider Name (Legal Business Name): PASADENA FOOT AND ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8023 RITCHIE HWY
PASADENA MD
21122-7107
US

IV. Provider business mailing address

8023 RITCHIE HWY
PASADENA MD
21122-7107
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-4190
  • Fax: 410-761-0265
Mailing address:
  • Phone: 410-761-3338
  • Fax: 410-761-0265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01059
License Number StateMD

VIII. Authorized Official

Name: DR. JOSEPH G PROEBSTLE
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 410-761-3338