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	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1316441777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Provider Business Mailing Address
First Line	:	1600 E GUDE DR STE 200
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-1496
Country	:	US
Telephone Number	:	301-933-7133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 WORTHINGTON BLVD STE 101
Second Line	:
City	:	URBANA
State	:	MD
Zip	:	21704-7018
Country	:	US
Telephone Number	:	301-969-0818
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DAVID J FREEDMAN
Credential	:
Telephone Number	:	301-598-0130

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	11/27/2018

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