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General NPI Number Information
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NPI Number | 1528736774
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Entity Type | Organization
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Legal Business Name | MARYLAND FOOT & ANKLE RESTORATION, LLC
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 6505 BELCREST RD STE 1
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City | HYATTSVILLE
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State | MD
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Zip | 20782-2011
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Country | US
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Telephone | 301-699-5900
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Fax | 301-699-9297
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Provider Business Mailing Address
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Address Line | PO BOX 83849
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City | GAITHERSBURG
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State | MD
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Zip | 20883-3849
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PODIATRIC SURGEON/MEDICAL DIRECTOR
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Name | DR. JOHNY J MOTRAN
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Credential |
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Telephone | 301-699-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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