Healthcare Provider Details

I. General information

NPI: 1356511448
Provider Name (Legal Business Name): BLUE RIDGE PODIATRY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 BILTMORE AVE
ASHEVILLE NC
28801-4142
US

IV. Provider business mailing address

246 BILTMORE AVE
ASHEVILLE NC
28801-4142
US

V. Phone/Fax

Practice location:
  • Phone: 828-254-5371
  • Fax: 828-254-4001
Mailing address:
  • Phone: 828-254-5371
  • Fax: 828-254-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL L WALDMAN
Title or Position: OWNER
Credential: DPM
Phone: 828-254-5371