Provider Demographics
NPI:1609834795
Name:WAX, ALLAN SCOTT (DPM)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:SCOTT
Last Name:WAX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13000 RIVERS BEND BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5106
Mailing Address - Fax:804-530-3015
Practice Address - Street 1:13048 RIVERS BEND RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2564
Practice Address - Country:US
Practice Address - Phone:804-526-5888
Practice Address - Fax:804-526-5401
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103000780213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU02838Medicare UPIN
VA4244940001Medicare NSC