Provider Demographics
NPI:1003962432
Name:AAL PODIATRY ASSOCIATES PC
Entity Type:Organization
Organization Name:AAL PODIATRY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:N
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-625-2962
Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-625-2962
Mailing Address - Fax:757-627-9861
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-625-2962
Practice Address - Fax:757-627-9861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD5480Medicare PIN
VA4395550001Medicare NSC
VAC01173Medicare UPIN