Provider Demographics
NPI:1508065335
Name:NORTHERN VIRGINIA FOOT & ANKLE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA FOOT & ANKLE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-734-1311
Mailing Address - Street 1:8221 OLD COURTHOUSE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3839
Mailing Address - Country:US
Mailing Address - Phone:703-734-1311
Mailing Address - Fax:703-734-9090
Practice Address - Street 1:8221 OLD COURTHOUSE RD STE 102
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3839
Practice Address - Country:US
Practice Address - Phone:703-734-1311
Practice Address - Fax:703-734-9090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300912213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0103000918OtherVIRGINIA STATE LICENSE
VA0103300912OtherVIRGINIA STATE LICENSE
VA0103000918OtherVIRGINIA STATE LICENSE
DC5362460001Medicare NSC