Provider Demographics
NPI:1346429123
Name:AFFILIATED FAN PODIATRY PC
Entity Type:Organization
Organization Name:AFFILIATED FAN PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANGERMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-435-5660
Mailing Address - Street 1:110 N ROBINSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4459
Mailing Address - Country:US
Mailing Address - Phone:804-358-9031
Mailing Address - Fax:804-358-1273
Practice Address - Street 1:110 N ROBINSON ST STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-358-9031
Practice Address - Fax:804-358-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00060306OtherMEDICARE RAILROAD
VA010011825Medicaid
VAC08845Medicare PIN
VA010011825Medicaid