MEDICARE: CAPITAL FOOT & ANKLE CARE CENTRE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083955405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPITAL FOOT & ANKLE CARE CENTRE PA

Provider Business Mailing Address
First Line	:	PO BOX 1310
Second Line	:
City	:	CALIFORNIA
State	:	MD
Zip	:	20619-1310
Country	:	US
Telephone Number	:	301-862-3338
Fax Number	:	301-862-3335

Provider Business Practice Location Address
First Line	:	995 PRINCE FREDERICK BLVD
Second Line	:	STE. 104
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3198
Country	:	US
Telephone Number	:	410-414-5033
Fax Number	:	301-862-3335

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. ROBERT L VANFOSSON
Credential	:	D.P.M
Telephone Number	:	301-862-3338

Provider Enumeration Date	:	03/11/2013
Last Update Date	:	03/11/2013

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Directions to “CAPITAL FOOT & ANKLE CARE CENTRE PA ” Practice Location

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