Provider Demographics
NPI:1598941106
Name:LIGHTFOOT PODIATRY CENTER, INC
Entity Type:Organization
Organization Name:LIGHTFOOT PODIATRY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:GARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-345-3679
Mailing Address - Street 1:213 BULIFANTS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5733
Mailing Address - Country:US
Mailing Address - Phone:757-345-3679
Mailing Address - Fax:
Practice Address - Street 1:213 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5733
Practice Address - Country:US
Practice Address - Phone:757-345-3679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10570Medicare PIN
VA6184960001Medicare NSC