Healthcare Provider Details

I. General information

NPI: 1265782080
Provider Name (Legal Business Name): STRONG FOUNDATIONS FOOT AND ANKLE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W ANNANDALE RD
FALLS CHURCH VA
22046-4226
US

IV. Provider business mailing address

PO BOX 8321
RESTON VA
20195-2221
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-3930
  • Fax: 703-649-4233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103001044
License Number StateVA

VIII. Authorized Official

Name: DR. GEORGE D LANE
Title or Position: PRESIDENT
Credential: MD
Phone: 703-786-6246