Provider Demographics
NPI:1558536961
Name:DOMINION FOOT AND ANKLE CENTER,LTD.
Entity Type:Organization
Organization Name:DOMINION FOOT AND ANKLE CENTER,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-378-1818
Mailing Address - Street 1:PO BOX 561
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-0561
Mailing Address - Country:US
Mailing Address - Phone:804-378-1818
Mailing Address - Fax:804-794-3827
Practice Address - Street 1:13305A MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4211
Practice Address - Country:US
Practice Address - Phone:804-378-1818
Practice Address - Fax:804-378-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000786213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480011660OtherRAILROAD MEDICARE PIN
VA9332014Medicaid
VA480000180Medicare PIN
VAT93575Medicare UPIN
VA0261540001Medicare NSC