Provider Demographics
NPI:1477739654
Name:GERARD J. RANIERI, DPM
Entity Type:Organization
Organization Name:GERARD J. RANIERI, DPM
Other - Org Name:LAKE RIDE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANIERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-491-2603
Mailing Address - Street 1:12656 LAKE RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7504
Mailing Address - Country:US
Mailing Address - Phone:703-491-2603
Mailing Address - Fax:703-491-0752
Practice Address - Street 1:12656 LAKE RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7504
Practice Address - Country:US
Practice Address - Phone:703-491-2603
Practice Address - Fax:703-491-0752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERARD J. RANIERI DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT93579Medicare UPIN
VA0647020001Medicare NSC
VA480017779Medicare PIN
VA480000214Medicare PIN