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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