Healthcare Provider Details

I. General information

NPI: 1700974243
Provider Name (Legal Business Name): PENINSULA FOOT & ANKLE SPECIALISTS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 EXECUTIVE DR SUITE A
HAMPTON VA
23666-6604
US

IV. Provider business mailing address

2202 EXECUTIVE DR SUITE A
HAMPTON VA
23666-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7111
  • Fax: 757-827-7164
Mailing address:
  • Phone: 757-827-7111
  • Fax: 757-827-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103000644
License Number StateVA

VIII. Authorized Official

Name: DR. ARNOLD SHERMAN BERESH
Title or Position: MANAGER
Credential: DPM
Phone: 757-827-7111