Healthcare Provider Details

I. General information

NPI: 1487762522
Provider Name (Legal Business Name): CARLA EMILIA RIBEIRO-BACHTELL DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE SUITE 602
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

4660 KENMORE AVE SUITE 602
ALEXANDRIA VA
22304-1535
US

V. Phone/Fax

Practice location:
  • Phone: 703-637-9917
  • Fax: 703-566-5201
Mailing address:
  • Phone: 703-637-9917
  • Fax: 703-566-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: