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General NPI Number Information
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NPI Number | 1346429123
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Entity Type | Organization
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Legal Business Name | AFFILIATED FAN PODIATRY PC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 110 N ROBINSON ST STE 105
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City | RICHMOND
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State | VA
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Zip | 23220
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Country | US
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Telephone | 804-358-9031
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Fax | 804-358-1273
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Provider Business Mailing Address
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Address Line | 110 N ROBINSON ST STE 105
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City | RICHMOND
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State | VA
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Zip | 23220-4459
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Country | US
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Telephone | 804-358-9031
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Fax | 804-358-1273
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Authorized Official
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Title or Position | OWNER
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Name | WESTON CHARLES ANGERMEIER
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Credential | DPM
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Telephone | 804-435-5660
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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 | 0103000600
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License Number State | VA
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