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General NPI Number Information
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NPI Number | 1770734915
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Entity Type | Organization
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Legal Business Name | LAUREL LAKES FOOT AND ANKLE CENTER, LLC
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 10/07/2008
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Provider Practice Location Address
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Address Line | 13950 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-5000
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Country | US
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Telephone | 301-317-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 13950 BALTIMORE AVE
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City | LAUREL
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State | MD
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Zip | 20707-5000
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Country | US
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Telephone | 301-317-6800
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Fax |
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Authorized Official
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Title or Position | DPM
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Name | DR. SCOTT W. NUTTER
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Credential |
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Telephone | 301-317-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 00560
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License Number State | MD
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