Provider Demographics
NPI:1194155663
Name:MARYLAND FOOT & ANKLE RESTORATION, LLC
Entity type:Organization
Organization Name:MARYLAND FOOT & ANKLE RESTORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/LEADING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNY
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:MOTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-699-5900
Mailing Address - Street 1:PO BOX 83849
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20883-3849
Mailing Address - Country:US
Mailing Address - Phone:301-699-5900
Mailing Address - Fax:301-699-9297
Practice Address - Street 1:6505 BELCREST RD
Practice Address - Street 2:SUITE 1
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2011
Practice Address - Country:US
Practice Address - Phone:301-699-5900
Practice Address - Fax:301-699-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01450332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415792300Medicaid
MD1114256062Medicare NSC