Healthcare Provider Details

I. General information

NPI: 1477068062
Provider Name (Legal Business Name): FOOT AND ANKLE SPECIALISTS OF THE MID-ATLANTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887A RIO EAST CT
CHARLOTTESVILLE VA
22901-8004
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-8116
  • Fax: 434-979-8880
Mailing address:
  • Phone: 301-933-7133
  • Fax: 301-933-7137

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: DAVID J FREEDMAN
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 301-598-0130