Healthcare Provider Details

I. General information

NPI: 1881746642
Provider Name (Legal Business Name): LYNNHAVEN FOOT AND ANKLE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1547 AMBERLEY FOREST RD
VIRGINIA BEACH VA
23453-4706
US

IV. Provider business mailing address

1547 AMBERLEY FOREST RD
VIRGINIA BEACH VA
23453-4706
US

V. Phone/Fax

Practice location:
  • Phone: 757-963-6363
  • Fax: 757-363-3453
Mailing address:
  • Phone: 757-963-6363
  • Fax: 757-363-3453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0103300951
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0103300951
License Number StateVA

VIII. Authorized Official

Name: DR. ANTHONY J. VUOLO JR.
Title or Position: PRESIDENT
Credential: DPM
Phone: 757-963-6363