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General NPI Number Information
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NPI Number | 1861477515
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Entity Type | Organization
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Legal Business Name | ABINGDON FOOT & ANKLE CLINIC PC
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 1231 W MAIN ST SUITE 100
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City | ABINGDON
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State | VA
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Zip | 24210-4705
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Country | US
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Telephone | 276-623-0333
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Fax | 276-623-0213
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Provider Business Mailing Address
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Address Line | 1231 W MAIN ST SUITE 100
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City | ABINGDON
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State | VA
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Zip | 24210-4705
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Country | US
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Telephone | 276-623-0333
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Fax | 276-623-0213
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. BRIAN J MAZZEI
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Credential | DPM
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Telephone | 276-623-0333
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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 | C103000942
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License Number State | VA
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