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General NPI Number Information
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NPI Number | 1417221219
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Entity Type | Organization
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Legal Business Name | NOVA FOOT & ANKLE CENTER, LLC
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Dates
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Enumeration Date | 02/27/2012
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 6151 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2541
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Country | US
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Telephone | 571-480-8480
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Fax | 703-888-3909
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Provider Business Mailing Address
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Address Line | 6151 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2541
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Country | US
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Telephone | 571-480-8480
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Fax | 703-888-3909
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Authorized Official
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Title or Position | OWNER
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Name | KOSTADINKA HADZIJSKA SKANDEVA
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Credential | DPM
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Telephone | 571-480-8480
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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 | 0103301045
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License Number State | VA
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