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Organization
LAUREL LAKES FOOT AND ANKLE ASC
Active
Organization
LAUREL LAKES FOOT AND ANKLE ASC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT W NUTTER DPM (PRESIDENT)
(301) 317-6800
Entity
Organization
Contact information
Practice address
13950 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 317-6800
(301) 317-4183
Mailing address
13950 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 317-6800
(301) 317-4183
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
00560
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001
BLUE SHIELD OF DC
DC
01
—
252513
BLUE SHIELD OF VA
VA
01
—
41866201
BLUE SHIELD OF MD
MD
01
—
496067
NCPPO
—
05
—
7998686000
—
MD
01
—
91242
MAMSI
MD
01
—
91242
AETNA
—
01
—
998E
TRICARE
—
01
—
A050
AMERIGROUP
—
Enumeration date
02/28/2008
Last updated
02/28/2008
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