Healthcare Provider Details

I. General information

NPI: 1417221219
Provider Name (Legal Business Name): NOVA FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6151 FULLER CT
ALEXANDRIA VA
22310-2541
US

IV. Provider business mailing address

6151 FULLER CT
ALEXANDRIA VA
22310-2541
US

V. Phone/Fax

Practice location:
  • Phone: 571-480-8480
  • Fax: 703-888-3909
Mailing address:
  • Phone: 571-480-8480
  • Fax: 703-888-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103301045
License Number StateVA

VIII. Authorized Official

Name: KOSTADINKA HADZIJSKA SKANDEVA
Title or Position: OWNER
Credential: DPM
Phone: 571-480-8480