Provider Demographics
NPI:1477805786
Name:JERALD A KRIGER PODIATRY ,PC
Entity Type:Organization
Organization Name:JERALD A KRIGER PODIATRY ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KRIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-330-4450
Mailing Address - Street 1:8605 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4583
Mailing Address - Country:US
Mailing Address - Phone:703-330-4450
Mailing Address - Fax:
Practice Address - Street 1:8605 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4583
Practice Address - Country:US
Practice Address - Phone:703-330-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA213ES0131X213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009300627Medicaid
VA009300627Medicaid
VAC258Medicare PIN