Healthcare Provider Details

I. General information

NPI: 1033288790
Provider Name (Legal Business Name): NORFOLK FOOT AND ANKLE GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOLLAND RD SUITE 106
VIRGINIA BEACH VA
23452-1900
US

IV. Provider business mailing address

4224 HOLLAND RD SUITE 106
VIRGINIA BEACH VA
23452-1900
US

V. Phone/Fax

Practice location:
  • Phone: 757-498-0202
  • Fax: 757-498-7936
Mailing address:
  • Phone: 757-498-0202
  • Fax: 757-498-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberVA0103000437
License Number StateVA

VIII. Authorized Official

Name: MRS. CYNTHIA LYNNE CALLOWAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-228-3735