Provider Demographics
NPI:1164489837
Name:GINGRICH, KRISTIN KAYE (DPM)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:KAYE
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 HICKORY PARK DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2628
Mailing Address - Country:US
Mailing Address - Phone:804-934-0661
Mailing Address - Fax:804-934-0663
Practice Address - Street 1:5230 HICKORY PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2628
Practice Address - Country:US
Practice Address - Phone:804-934-0661
Practice Address - Fax:804-934-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300817213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140044OtherANTHEM PROVIDER ID
VA480030840OtherMEDICARE RR
VA286847OtherMAMSI
VA130184OtherSOUTHERN HEALTH
VAU76192Medicare UPIN
VA286847OtherMAMSI