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General NPI Number Information
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NPI Number | 1427260751
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Entity Type | Organization
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Legal Business Name | CHANTILLY FOOT AND ANKLE CENTER ,LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14904 JEFFERSON DAVIS HWY SUITE 308
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3908
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Country | US
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Telephone | 703-490-5599
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 220734
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City | CHANTILLY
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State | VA
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Zip | 20153-0734
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Country | US
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Telephone | 703-490-5599
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. FARSHAD R BATHAEE
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Credential | DPM
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Telephone | 703-490-5599
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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 | 0103300742
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License Number State | VA
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