Provider Demographics
NPI:1760401921
Name:VIRGINIA FOOT & ANKLE SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:VIRGINIA FOOT & ANKLE SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DISABATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-962-4460
Mailing Address - Street 1:103 S PANTOPS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8617
Mailing Address - Country:US
Mailing Address - Phone:434-977-8040
Mailing Address - Fax:434-977-8083
Practice Address - Street 1:103 S PANTOPS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8617
Practice Address - Country:US
Practice Address - Phone:434-977-8040
Practice Address - Fax:434-977-8083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009300660Medicaid
VA009300660Medicaid
VA0908440001Medicare NSC