Provider Demographics
NPI:1902182660
Name:CLIFTON FOOT AND ANKLE CENTER P.C.
Entity Type:Organization
Organization Name:CLIFTON 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:KENNETH
Authorized Official - Middle Name:REED
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-996-3000
Mailing Address - Street 1:6101 REDWOOD SQUARE CTR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4265
Mailing Address - Country:US
Mailing Address - Phone:703-996-3000
Mailing Address - Fax:703-229-1152
Practice Address - Street 1:6101 REDWOOD SQUARE CENTER
Practice Address - Street 2:SUITE 303
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4269
Practice Address - Country:US
Practice Address - Phone:703-996-3000
Practice Address - Fax:703-229-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000986213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6614380001OtherDME PTAN
VA009302531Medicaid
VA901203Medicare PIN
VA6614380001OtherDME PTAN
VAU65884Medicare PIN