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	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1295515955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Provider Business Mailing Address
First Line	:	199 E MONTGOMERY AVE STE 100
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-2361
Country	:	US
Telephone Number	:	301-933-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1004 WERRINGTON DR STE 300
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-6018
Country	:	US
Telephone Number	:	919-850-9111
Fax Number	:	919-850-2499

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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