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General NPI Number Information
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NPI Number | 1376795765
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Entity Type | Organization
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Legal Business Name | ASSOCIATED FOOT & ANKLE CENTERS OF NORTHERN VIRGINIA PC
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Dates
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Enumeration Date | 10/16/2008
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 10730 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22030-3704
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Country | US
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Telephone | 703-691-0670
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Fax | 703-385-2865
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Provider Business Mailing Address
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Address Line | 1721 FINANCIAL LOOP
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City | LAKE RIDGE
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State | VA
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Zip | 22192-2460
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Country | US
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Telephone | 703-491-9500
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Fax | 703-491-9994
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLAS E STABILE
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Credential | DPM
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Telephone | 703-491-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0103000774
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License Number State | VA
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