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Organization
FOOT AND ANKLE CARE OF FREDERICK, INC
Active
Organization
FOOT AND ANKLE CARE OF FREDERICK, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID MARK GRACE DPM (OWNER)
(301) 698-9260
Entity
Organization
Contact information
Practice address
604 SOLAREX CT, UNIT 103, FREDERICK, MD 21703-8678
(301) 698-9260
(301) 698-8962
Mailing address
604 SOLAREX CT, UNIT 103, FREDERICK, MD 21703-8678
(301) 698-9260
(301) 698-8962
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
01249
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019538300
DME - MEDICAID
MD
01
—
1457320814
INDIVIDUAL NPI
MD
05
—
403808800
—
MD
05
—
403808801
—
MD
01
—
DD4719
MEDICARE RAILROAD
MD
Enumeration date
06/23/2006
Last updated
11/11/2009
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