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General NPI Number Information
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NPI Number | 1962596031
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Entity Type | Organization
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Legal Business Name | LARGO FOOT & ANKLE HEALTH CENTER AND AMBULATORY SURGICAL CENTER,INC'
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1450 MERCANTILE LN STE 151
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City | UPPER MARLBORO
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State | MD
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Zip | 20774-5386
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Country | US
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Telephone | 301-386-5453
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Fax | 301-386-5396
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | FULTON
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State | MD
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Zip | 20759-0265
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Country | US
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Telephone | 301-386-5453
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Fax | 301-386-5396
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADEMUYIWA ADEKOLA ADETUNJI
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Credential | DPM
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Telephone | 301-386-5453
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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 | 01264
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License Number State | MD
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