Healthcare Provider Details

I. General information

NPI: 1285767624
Provider Name (Legal Business Name): BEDFORD PODIATRY & FOOT SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

876 E MAIN ST
BEDFORD VA
24523-2904
US

IV. Provider business mailing address

876 E MAIN ST
BEDFORD VA
24523-2904
US

V. Phone/Fax

Practice location:
  • Phone: 540-587-6963
  • Fax: 540-587-6962
Mailing address:
  • Phone: 540-587-6963
  • Fax: 540-587-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000619
License Number StateVA

VIII. Authorized Official

Name: DR. ROBERT FELDMAN
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 540-587-6963