Provider Demographics
NPI:1356603922
Name:CARDINAL, GREGORY JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:CARDINAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1015 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1349
Mailing Address - Country:US
Mailing Address - Phone:612-382-6490
Mailing Address - Fax:703-879-5951
Practice Address - Street 1:2201 MOUNT VERNON AVE STE 105
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22301
Practice Address - Country:US
Practice Address - Phone:703-879-5155
Practice Address - Fax:703-879-5951
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPO1000119213E00000X
MD01579213E00000X
VA0103301144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist