Provider Demographics
NPI:1003926031
Name:VANTRE, SCOTT THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:THOMAS
Last Name:VANTRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2004 BREMO RD
Mailing Address - Street 2:200 VIRGINIA FOOT & ANKLE CENTER PC
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-285-3933
Mailing Address - Fax:804-288-1384
Practice Address - Street 1:2004 BREMO RD
Practice Address - Street 2:200 VIRGINIA FOOT & ANKLE CENTER PC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-285-3933
Practice Address - Fax:804-288-1384
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300918213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010119570Medicaid
VA165546OtherANTHEM
00W192V01Medicare ID - Type Unspecified
VA165546OtherANTHEM