Healthcare Provider Details

I. General information

NPI: 1538279260
Provider Name (Legal Business Name): HAMPTON ROADS PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 PRINCESS ANNE ROAD SUITE 102
VA BEACH VA
23462
US

IV. Provider business mailing address

5241 PRINCESS ANNE ROAD SUITE 102
VA BEACH VA
23462
US

V. Phone/Fax

Practice location:
  • Phone: 757-497-0859
  • Fax: 757-497-0976
Mailing address:
  • Phone: 757-497-0859
  • Fax: 757-497-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103001041
License Number StateVA

VIII. Authorized Official

Name: DR. RUDOLPH CLINTON ANDERSON JR.
Title or Position: PRESIDENT
Credential:
Phone: 757-497-0859