Healthcare Provider Details

I. General information

NPI: 1629428750
Provider Name (Legal Business Name): NOVA FOOT AND ANKLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 BACKLICK CT
SPRINGFIELD VA
22151-3937
US

IV. Provider business mailing address

112 ELDEN ST STE D
HERNDON VA
20170-4832
US

V. Phone/Fax

Practice location:
  • Phone: 703-642-5340
  • Fax:
Mailing address:
  • Phone: 703-437-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301005
License Number StateVA

VIII. Authorized Official

Name: DR. AMI PARIKH
Title or Position: PRESIDENT
Credential: DPM
Phone: 703-437-5353