Healthcare Provider Details

I. General information

NPI: 1245251917
Provider Name (Legal Business Name): NEW AGE FOOT & ANKLE SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 SPRINGFIELD RD
GLEN ALLEN VA
23060-4119
US

IV. Provider business mailing address

3936 SPRINGFIELD RD
GLEN ALLEN VA
23060
US

V. Phone/Fax

Practice location:
  • Phone: 804-934-9340
  • Fax: 804-934-9381
Mailing address:
  • Phone: 804-934-9340
  • Fax: 804-934-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4605650001
License Number StateVA

VIII. Authorized Official

Name: MRS. PATRICIA SAPPINGTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-934-9340