Healthcare Provider Details

I. General information

NPI: 1346429123
Provider Name (Legal Business Name): AFFILIATED FAN PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N ROBINSON ST STE 105
RICHMOND VA
23220
US

IV. Provider business mailing address

110 N ROBINSON ST STE 105
RICHMOND VA
23220-4459
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-9031
  • Fax: 804-358-1273
Mailing address:
  • Phone: 804-358-9031
  • Fax: 804-358-1273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000600
License Number StateVA

VIII. Authorized Official

Name: WESTON CHARLES ANGERMEIER
Title or Position: OWNER
Credential: DPM
Phone: 804-435-5660