Provider Demographics
NPI:1689776114
Name:KANDER, RODNEY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:A
Last Name:KANDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:VA
Mailing Address - Zip Code:20197-0234
Mailing Address - Country:US
Mailing Address - Phone:703-727-3689
Mailing Address - Fax:
Practice Address - Street 1:14200 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:LOVETTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:20180-3314
Practice Address - Country:US
Practice Address - Phone:703-727-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000592213EP1101X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302921Medicaid
VA9302921Medicaid
VA9302921Medicaid