Healthcare Provider Details

I. General information

NPI: 1922554450
Provider Name (Legal Business Name): CDM FOOT AND ANKLE PAIN AND SPRAIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 ROLLING RD SUITE 116
SPRINGFIELD VA
22152-1521
US

IV. Provider business mailing address

6116 ROLLING RD SUITE 116
SPRINGFIELD VA
22152-1521
US

V. Phone/Fax

Practice location:
  • Phone: 571-216-5467
  • Fax: 703-866-7077
Mailing address:
  • Phone: 571-216-5467
  • Fax: 703-866-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103301168
License Number StateVA

VIII. Authorized Official

Name: TON Q HO
Title or Position: OWNER
Credential:
Phone: 571-216-5467