MEDICARE: FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	213ES0103X	Foot & Ankle Surgery Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1114569100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Provider Business Mailing Address
First Line	:	PO BOX 825159
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-5159
Country	:	US
Telephone Number	:	301-933-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	10370 PARK RD STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-8509
Country	:	US
Telephone Number	:	704-542-8253
Fax Number	:

Authorized Official
Title or Position	:	DPM/OWNER
Name	:	MICHAEL TRITTO
Credential	:
Telephone Number	:	301-933-7133

Provider Enumeration Date	:	10/11/2019
Last Update Date	:	02/10/2025

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