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General NPI Number Information
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NPI Number | 1316184518
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Entity Type | Organization
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Legal Business Name | MID-ATLANTIC FOOTCARE
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Dates
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Enumeration Date | 01/10/2009
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Last Update Date | 01/10/2009
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Provider Practice Location Address
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Address Line | 1401 TIDEWATER DR STE 1
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City | NORFOLK
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State | VA
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Zip | 23504-2840
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Country | US
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Telephone | 757-963-8868
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Fax | 757-963-8867
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Provider Business Mailing Address
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Address Line | 1401 TIDEWATER DR STE 1
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City | NORFOLK
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State | VA
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Zip | 23504-2840
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Country | US
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Telephone | 757-963-8868
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Fax | 757-963-8867
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK MERCER III
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Credential | DPM
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Telephone | 757-963-8868
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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 | 0103000848
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License Number State | VA
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