Provider Demographics
NPI:1295702108
Name:VETTER, STEVEN R (DPM)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:VETTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10721 MAIN ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6914
Mailing Address - Country:US
Mailing Address - Phone:703-352-8888
Mailing Address - Fax:703-352-8994
Practice Address - Street 1:10721 MAIN ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6914
Practice Address - Country:US
Practice Address - Phone:703-352-8888
Practice Address - Fax:703-352-8994
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0130000659213E00000X, 213EP1101X, 213ES0000X, 213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0479150001Medicare NSC
VAT31201Medicare UPIN