Healthcare Provider Details

I. General information

NPI: 1316476161
Provider Name (Legal Business Name): COLBY MUSSETT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 VIRGINIA OAKS DR STE 104
GAINESVILLE VA
20155-3831
US

IV. Provider business mailing address

7521 VIRGINIA OAKS DR STE 104
GAINESVILLE VA
20155-3831
US

V. Phone/Fax

Practice location:
  • Phone: 703-743-5457
  • Fax: 703-454-5778
Mailing address:
  • Phone: 703-743-5457
  • Fax: 703-454-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0103301297
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0103301297
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: