=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912188376
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE BURKE FOOT AND ANKLE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2007
-----------------------------------------------------
Last Update Date | 09/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5631 BURKE CENTRE PKWY STE K
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-250-2904
-----------------------------------------------------
Fax | 703-250-2939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5631 BURKE CENTRE PKWY SUITE K
-----------------------------------------------------
City | BURKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22015-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-250-2904
-----------------------------------------------------
Fax | 703-250-2939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. GARY J. ARMINIO
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 703-250-2904
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 0103000622
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------