Provider Demographics
NPI:1295200681
Name:COMMONWEALTH FOOT AND ANKLE, INC.
Entity Type:Organization
Organization Name:COMMONWEALTH FOOT AND ANKLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOURAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-234-2905
Mailing Address - Street 1:453 MCLAWS CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5621
Mailing Address - Country:US
Mailing Address - Phone:757-220-3311
Mailing Address - Fax:
Practice Address - Street 1:3333 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9276
Practice Address - Country:US
Practice Address - Phone:804-732-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty