Provider Demographics
NPI:1033288790
Name:NORFOLK FOOT AND ANKLE GROUP PC
Entity Type:Organization
Organization Name:NORFOLK FOOT AND ANKLE GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-228-3735
Mailing Address - Street 1:4224 HOLLAND RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1900
Mailing Address - Country:US
Mailing Address - Phone:757-498-0202
Mailing Address - Fax:757-498-7936
Practice Address - Street 1:4224 HOLLAND RD
Practice Address - Street 2:SUITE 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1900
Practice Address - Country:US
Practice Address - Phone:757-498-0202
Practice Address - Fax:757-498-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0103000437213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100566OtherOPTIMA
VA5180770001Medicare NSC
VACD3488Medicare PIN
VACD3588Medicare PIN
VA5180770002Medicare NSC
VAC03803Medicare PIN