Provider Demographics
NPI:1780852715
Name:FASV PC
Entity Type:Organization
Organization Name:FASV PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-746-5488
Mailing Address - Street 1:7016 LEE PARK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3620
Mailing Address - Country:US
Mailing Address - Phone:804-746-5488
Mailing Address - Fax:804-730-1223
Practice Address - Street 1:7016 LEE PARK RD STE 105
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3620
Practice Address - Country:US
Practice Address - Phone:804-746-5488
Practice Address - Fax:804-730-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000846213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6410030005Medicare NSC