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General NPI Number Information
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NPI Number | 1184101065
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH FOOT & ANKLE SPECIALISTS LLC
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 07/24/2018
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Provider Practice Location Address
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Address Line | 2552 ALDRIDGE AVE
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City | SOUTH CHESTERFIELD
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State | VA
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Zip | 23834-5306
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Country | US
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Telephone | 804-365-5898
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Fax |
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Provider Business Mailing Address
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Address Line | 4704 BARREL POINT RD
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City | PRINCE GEORGE
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State | VA
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Zip | 23875-2976
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Country | US
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Telephone | 305-206-7638
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Fax |
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Authorized Official
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Title or Position | FOOT & ANKLE SPECIALIST
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Name | DR. JUSTIN A PHILLINGANE
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Credential | DPM
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Telephone | 804-365-5898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103301225
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License Number State | VA
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