Healthcare Provider Details

I. General information

NPI: 1194909945
Provider Name (Legal Business Name): NATIONAL CAPITAL FOOT & ANKLE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 PARK POTOMAC AVE STE R2
POTOMAC MD
20854
US

IV. Provider business mailing address

12400 PARK POTOMAC AVE STE R2
POTOMAC MD
20854-7024
US

V. Phone/Fax

Practice location:
  • Phone: 301-983-8202
  • Fax: 877-810-5148
Mailing address:
  • Phone: 301-983-8202
  • Fax: 877-810-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPO1000050
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. FRANKLIN RANDALL POLUN
Title or Position: OWNER
Credential: DPM
Phone: 202-966-0900