1518312289 NPI number — FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Table of content: MRS. AMY LEIGH KENYON RN (NPI 1477291094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518312289 NPI number — FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518312289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 E GUDE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-933-7133
Provider Business Mailing Address Fax Number:
301-933-7137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 PEACH ORCHARD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC CONNELLSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17233-8559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-739-1575
Provider Business Practice Location Address Fax Number:
301-739-1578
Provider Enumeration Date:
04/29/2016

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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