Healthcare Provider Details

I. General information

NPI: 1730507138
Provider Name (Legal Business Name): VISITING PODIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIR SUITE 105A
WILLIAMSBURG VA
23185-5674
US

IV. Provider business mailing address

PO BOX 4839
TROY MI
48099-4839
US

V. Phone/Fax

Practice location:
  • Phone: 757-561-2840
  • Fax: 855-252-2434
Mailing address:
  • Phone: 248-824-6600
  • Fax: 248-324-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LYNN A. BEATTY
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 248-824-6000