Provider Demographics
NPI:1700974243
Name:PENINSULA FOOT & ANKLE SPECIALISTS PLC
Entity Type:Organization
Organization Name:PENINSULA FOOT & ANKLE SPECIALISTS PLC
Other - Org Name:PENINSULA FOOT AND ANKLE SPECIALISTS, PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:SHERMAN
Authorized Official - Last Name:BERESH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-827-7111
Mailing Address - Street 1:2202 EXECUTIVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7111
Mailing Address - Fax:757-827-7164
Practice Address - Street 1:2202 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6604
Practice Address - Country:US
Practice Address - Phone:757-827-7111
Practice Address - Fax:757-827-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000644213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1321420001Medicare NSC