Healthcare Provider Details

I. General information

NPI: 1003812124
Provider Name (Legal Business Name): MONTGOMERY FOOT AND ANKLE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 UNIVERSITY BLVD W SUITE 1000
WHEATON MD
20902-1905
US

IV. Provider business mailing address

2730 UNIVERSITY BLVD W SUITE 1000
WHEATON MD
20902-1905
US

V. Phone/Fax

Practice location:
  • Phone: 301-949-3668
  • Fax: 301-949-8833
Mailing address:
  • Phone: 301-949-3668
  • Fax: 301-949-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01072
License Number StateMD

VIII. Authorized Official

Name: ADAM SPECTOR
Title or Position: OWNER
Credential:
Phone: 301-589-8886