Provider Demographics
NPI:1316117963
Name:CROWNSVILLE FOOT AND ANKLE CENTER LLC
Entity type:Organization
Organization Name:CROWNSVILLE FOOT AND ANKLE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STOREY-CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-806-3198
Mailing Address - Street 1:1321 GENERALS HWY
Mailing Address - Street 2:STE 101
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2060
Mailing Address - Country:US
Mailing Address - Phone:443-517-3171
Mailing Address - Fax:
Practice Address - Street 1:1321 GENERALS HWY
Practice Address - Street 2:STE 101
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2060
Practice Address - Country:US
Practice Address - Phone:443-517-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01337213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty