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General NPI Number Information
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NPI Number | 1922520063
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Entity Type | Organization
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Legal Business Name | MARYLAND FOOT & ANKLE RECONSTRUCTION GROUP LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14301 AUTUMN GOLD RD
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City | BOYDS
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State | MD
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Zip | 20841-4208
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Country | US
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Telephone | 571-830-7983
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Fax |
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Provider Business Mailing Address
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Address Line | 14301 AUTUMN GOLD RD
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City | BOYDS
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State | MD
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Zip | 20841-4208
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Country | US
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Telephone | 571-830-7983
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PODIATRIC MEDICINE
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Name | NAVID SADOUGHI
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Credential | DPM
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Telephone | 571-830-7983
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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 | 01623
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License Number State | MD
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