MEDICARE: DR. JUSTIN ANDREW PHILLINGANE D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0103301225	VA

General Provider Information

NPI Number	:	1548642788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN ANDREW PHILLINGANE D.P.M.

Provider Business Mailing Address
First Line	:	40 MEDICAL PARK BLVD STE A
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9289
Country	:	US
Telephone Number	:	804-732-6000
Fax Number	:	804-504-1900

Provider Business Practice Location Address
First Line	:	40 MEDICAL PARK BLVD STE A
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-9289
Country	:	US
Telephone Number	:	804-732-6000
Fax Number	:	804-504-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	03/05/2026

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