Provider Demographics
NPI:1528736774
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:PODIATRIC SURGEON/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
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:
Mailing Address - Fax:
Practice Address - Street 1:6505 BELCREST RD STE 1
Practice Address - Street 2:
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:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty