Provider Demographics
NPI:1760570279
Name:VIRGINIA PODIATRY PC
Entity Type:Organization
Organization Name:VIRGINIA PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-495-6113
Mailing Address - Street 1:5253 PROVIDENCE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-495-6113
Mailing Address - Fax:757-495-6156
Practice Address - Street 1:5253 PROVIDENCE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-495-6113
Practice Address - Fax:757-495-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty