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	:	1871364778
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 SUMMERFIELD CT STE 102
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24019-4579
Country	:	US
Telephone Number	:	540-904-1458
Fax Number	:

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

Provider Enumeration Date	:	01/10/2024
Last Update Date	:	02/25/2025

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