=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518194059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON VICENTE NALDO D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2009
-----------------------------------------------------
Last Update Date | 03/03/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 LAMB CIR SUITE L-760
-----------------------------------------------------
City | CHRISTIANSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24073-6344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-731-2436
-----------------------------------------------------
Fax | 540-731-2439
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 LAMB CIR SUITE L-760
-----------------------------------------------------
City | CHRISTIANSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24073-6344
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-731-2436
-----------------------------------------------------
Fax | 540-731-2439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0103301066
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------