Provider Demographics
NPI:1821263526
Name:PAV, PLLC
Entity Type:Organization
Organization Name:PAV, PLLC
Other - Org Name:PODIATRY ASSOCIATES OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-228-1955
Mailing Address - Street 1:936 A GENERAL BOOTH BLVD.
Mailing Address - Street 2:VIRGINIA BEACH
Mailing Address - City:VIRGINIA
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4857
Mailing Address - Country:US
Mailing Address - Phone:757-228-1980
Mailing Address - Fax:757-228-3095
Practice Address - Street 1:936 A GENERAL BOOTH BLVD.
Practice Address - Street 2:VIRGINIA BEACH
Practice Address - City:VIRGINIA
Practice Address - State:VA
Practice Address - Zip Code:23451-4857
Practice Address - Country:US
Practice Address - Phone:757-228-1980
Practice Address - Fax:757-228-3095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6202030001Medicare NSC