Healthcare Provider Details

I. General information

NPI: 1417183534
Provider Name (Legal Business Name): SPRINGFIELD FOOT & ANKLE CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 06/03/2009
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: 703-569-2444
  • Fax: 703-569-5667
Mailing address:
  • Phone: 703-569-2444
  • Fax: 703-569-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number0103000282
License Number StateVA

VIII. Authorized Official

Name: DR. STEVEN ELLIS LIPSON
Title or Position: PRES
Credential: D.P.M.
Phone: 703-569-2444