Provider Demographics
NPI:1578735064
Name:FOOT AND ANKLE SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:FOOT AND ANKLE SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:8043-302-3235
Mailing Address - Street 1:9766 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4973
Mailing Address - Country:US
Mailing Address - Phone:804-330-2467
Mailing Address - Fax:804-330-3366
Practice Address - Street 1:9766 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4973
Practice Address - Country:US
Practice Address - Phone:804-330-2467
Practice Address - Fax:804-330-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000905213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU17938Medicare UPIN
VA5106090002Medicare NSC