Healthcare Provider Details

I. General information

NPI: 1427105949
Provider Name (Legal Business Name): 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 NORTH MAIN STREET
SUFFOLK VA
23434
US

IV. Provider business mailing address

171 N MAIN ST
SUFFOLK VA
23434-4507
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-0768
  • Fax: 757-925-1901
Mailing address:
  • Phone: 757-934-0768
  • Fax: 757-925-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103300887
License Number StateVA

VIII. Authorized Official

Name: DR. MATTHEW CRAIG DAIRMAN
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: DPM, FACFAS
Phone: 757-934-0768