Provider Demographics
NPI:1750452694
Name:FAIRFAX FOOT AND ANKLE CENTER, P.C.
Entity Type:Organization
Organization Name:FAIRFAX FOOT AND ANKLE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-273-3622
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6914
Mailing Address - Country:US
Mailing Address - Phone:703-273-3622
Mailing Address - Fax:703-273-0313
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-273-3622
Practice Address - Fax:703-273-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000250213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303791Medicaid
8665OtherCAREFIRST BCBS
2153713OtherAETNA HMO PLANS
0604177OtherCIGNA INSURANCE
346199PPOOtherNCPPO
51277OtherOP-CHOICE, MDIPA
VA207996OtherANTHEM BC BS
4313936OtherAETNA NON HMO PLANS
51277OtherALLIANCE
VAT30913Medicare UPIN
VA009303791Medicaid
VAG01788Medicare PIN