Provider Demographics
NPI:1912037698
Name:PODIATRY ASSOCIATES OF VIRGINIA PC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM PRESIDENT
Authorized Official - Prefix:
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 1:936A GENERAL BOOTH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4857
Mailing Address - Country:US
Mailing Address - Phone:757-228-1955
Mailing Address - Fax:
Practice Address - Street 1:936A GENERAL BOOTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4857
Practice Address - Country:US
Practice Address - Phone:757-228-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6049390001Medicare NSC