Provider Demographics
NPI:1811950207
Name:FOOT SURGI-CENTER OF OWINGS MILLS LLC
Entity type:Organization
Organization Name:FOOT SURGI-CENTER OF OWINGS MILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-363-2233
Mailing Address - Street 1:25 CROSSROADS DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:410-363-2233
Mailing Address - Fax:410-363-2235
Practice Address - Street 1:25 CROSSROADS DRIVE
Practice Address - Street 2:SUITE 410
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117
Practice Address - Country:US
Practice Address - Phone:410-363-2233
Practice Address - Fax:410-363-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1397335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5463740001Medicare ID - Type UnspecifiedADMINISTRATOR