Provider Demographics
NPI:1093036857
Name:ADVANCED FOOT & ANKLE CARE LLC
Entity Type:Organization
Organization Name:ADVANCED FOOT & ANKLE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-301-9996
Mailing Address - Street 1:2117 MCCOMAS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3908
Mailing Address - Country:US
Mailing Address - Phone:757-301-9996
Mailing Address - Fax:757-301-9958
Practice Address - Street 1:2117 MCCOMAS WAY STE 102
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-3908
Practice Address - Country:US
Practice Address - Phone:757-301-9996
Practice Address - Fax:757-301-9958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-16
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001037213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9303499Medicaid
VA9303499Medicaid
VAU71614Medicare UPIN
VA480000601Medicare PIN