| |
24430 Stone Springs Blvd., Suite 100, Dulles, VA 20166-2016 | |
(703) 753-3338 | |
(703) 753-7870 |
Full Name | |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 24430 Stone Springs Blvd., Dulles, Virginia |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1225708019 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
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224d Cornwall St Nw Ste 403, Leesburg, VA 20176-2704 Ph: (703) 737-6001 | 24430 Stone Springs Blvd., Suite 100, Dulles, VA 20166-2016 Ph: (703) 753-3338 |