Provider Demographics
NPI:1083395792
Name:TAPPAHANNOCK FOOT AND ANKLE SPECIALIST INC
Entity Type:Organization
Organization Name:TAPPAHANNOCK FOOT AND ANKLE SPECIALIST INC
Other - Org Name:TAPPAHANNOCK FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOON
Authorized Official - Middle Name:S
Authorized Official - Last Name:HWANG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-925-6027
Mailing Address - Street 1:402 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:TAPPAHANNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22560-5431
Mailing Address - Country:US
Mailing Address - Phone:804-925-6027
Mailing Address - Fax:804-925-6024
Practice Address - Street 1:402 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5431
Practice Address - Country:US
Practice Address - Phone:804-925-6027
Practice Address - Fax:804-925-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty