Healthcare Provider Details

I. General information

NPI: 1932023041
Provider Name (Legal Business Name): FOOT AND ANKLE SPECIALISTS OF THE MID ATLANTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 JOHNSTON WILLIS DR
NORTH CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-3668
  • Fax:
Mailing address:
  • Phone: 866-626-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TRITTO
Title or Position: OWNER
Credential:
Phone: 301-933-7133