Healthcare Provider Details

I. General information

NPI: 1295702108
Provider Name (Legal Business Name): STEVEN R VETTER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 MAIN ST SUITE 3500
FAIRFAX VA
22030-6914
US

IV. Provider business mailing address

10721 MAIN ST SUITE 3500
FAIRFAX VA
22030-6914
US

V. Phone/Fax

Practice location:
  • Phone: 703-352-8888
  • Fax: 703-352-8994
Mailing address:
  • Phone: 703-352-8888
  • Fax: 703-352-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0130000659
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0130000659
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0130000659
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0130000659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: