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General NPI Number Information
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NPI Number | 1376565234
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA PODIATRY GROUP, P.C.
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 19440 GOLF VISTA PLZ SUITE 120
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City | LEESBURG
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State | VA
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Zip | 20176-8263
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Country | US
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Telephone | 703-858-7887
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Fax | 703-858-7453
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Provider Business Mailing Address
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Address Line | 19440 GOLF VISTA PLZ SUITE 120
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City | LEESBURG
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State | VA
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Zip | 20176-8263
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Country | US
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Telephone | 703-858-7887
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Fax | 703-858-7453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY KUGLER
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Credential | D.P.M.
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Telephone | 703-885-7887
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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 |
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License Number State |
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