MEDICARE: ALICK AMINI C PED

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	224L00000X	Pedorthist

General Provider Information

NPI Number	:	1962972638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICK AMINI C PED

Provider Business Mailing Address
First Line	:	1621 QUAIL RUN
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22911-9054
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1366 CHAIN BRIDGE RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3904
Country	:	US
Telephone Number	:	703-760-0950
Fax Number	:

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	11/26/2018

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Directions to “ ALICK AMINI C PED” Practice Location

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