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General NPI Number Information
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NPI Number | 1427105949
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Entity Type | Organization
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Legal Business Name | 1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 171 NORTH MAIN STREET
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City | SUFFOLK
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State | VA
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Zip | 23434
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Country | US
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Telephone | 757-934-0768
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Fax | 757-925-1901
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Provider Business Mailing Address
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Address Line | 171 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4507
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Country | US
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Telephone | 757-934-0768
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Fax | 757-925-1901
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. MATTHEW CRAIG DAIRMAN
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Credential | DPM, FACFAS
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Telephone | 757-934-0768
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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 | 0103300887
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License Number State | VA
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