Provider Demographics
NPI:1164449864
Name:GIRVAN, ROSS JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JAMES
Last Name:GIRVAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:611 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8402
Mailing Address - Country:US
Mailing Address - Phone:540-374-5261
Mailing Address - Fax:540-374-5066
Practice Address - Street 1:611 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8402
Practice Address - Country:US
Practice Address - Phone:540-374-5261
Practice Address - Fax:540-374-5066
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000992213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009302271Medicaid
VA009302271Medicaid
VAU49912Medicare UPIN
VA190002176Medicare PIN