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Organization
LAUREL LAKES FOOT AND ANKLE CENTER, LLC
Active
Organization
LAUREL LAKES FOOT AND ANKLE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT W. NUTTER (DPM)
(301) 317-6800
Entity
Organization
Contact information
Practice address
13950 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 317-6800
Mailing address
13950 BALTIMORE AVE, LAUREL, MD 20707-5000
(301) 317-6800
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
AMERGROUP
—
Enumeration date
10/07/2008
Last updated
10/07/2008
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