Healthcare Provider Details

I. General information

NPI: 1528480647
Provider Name (Legal Business Name): ALLCARE FOOT & ANKLE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 PARK AVE SUITE #308
FALLS CHURCH VA
22046-3327
US

IV. Provider business mailing address

313 PARK AVE SUITE #308
FALLS CHURCH VA
22046-3327
US

V. Phone/Fax

Practice location:
  • Phone: 703-462-8145
  • Fax: 703-462-9025
Mailing address:
  • Phone: 703-462-8145
  • Fax: 703-462-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO1000010
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300864
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01354
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300864
License Number StateVA

VIII. Authorized Official

Name: DR. KAVEH SOLTANI
Title or Position: MEMBER MANAGER
Credential: DPM
Phone: 301-706-5256