Provider Demographics
NPI:1174680540
Name:RESTON PODIATRY ASSOCIATES LTD
Entity Type:Organization
Organization Name:RESTON PODIATRY ASSOCIATES LTD
Other - Org Name:LEESBURG FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-368-7166
Mailing Address - Street 1:211 GIBSON ST NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2115
Mailing Address - Country:US
Mailing Address - Phone:703-777-2101
Mailing Address - Fax:703-777-4431
Practice Address - Street 1:211 GIBSON STREET NW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:703-777-2101
Practice Address - Fax:703-777-4431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00618798Medicare PIN
VA0442570004Medicare NSC
VADN4147Medicare PIN
VA480000470Medicare PIN
VA480018959Medicare PIN
VACC5940Medicare PIN
VAC01127Medicare PIN