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General NPI Number Information
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NPI Number | 1285125930
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Entity Type | Organization
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Legal Business Name | NOVA PODIATRY AND WOUND CARE CENTER LLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 1880 HOWARD AVE STE 202
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City | VIENNA
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State | VA
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Zip | 22182
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Country | US
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Telephone | 703-863-9393
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Fax |
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Provider Business Mailing Address
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Address Line | 1880 HOWARD AVE STE 202
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City | VIENNA
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State | VA
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Zip | 22182-2611
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Country | US
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Telephone | 703-863-9393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARIN ASHKAN
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Credential |
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Telephone | 703-651-5850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0103301227
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License Number State | VA
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