Provider Demographics
NPI:1770828527
Name:NOVA FOOT AND ANKLE
Entity type:Organization
Organization Name:NOVA FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMI
Authorized Official - Middle Name:PARIKH
Authorized Official - Last Name:IDICULLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-437-5353
Mailing Address - Street 1:112 ELDEN ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4874
Mailing Address - Country:US
Mailing Address - Phone:703-437-5353
Mailing Address - Fax:
Practice Address - Street 1:112 ELDEN ST
Practice Address - Street 2:SUITE D
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4874
Practice Address - Country:US
Practice Address - Phone:703-437-5353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7004550001OtherPTAN
1477790533OtherINDIVIDUAL NPI
1477790533OtherINDIVIDUAL NPI
VA7004550001Medicare NSC