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General NPI Number Information
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NPI Number | 1922554450
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Entity Type | Organization
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Legal Business Name | CDM FOOT AND ANKLE PAIN AND SPRAIN LLC
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 08/25/2016
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Provider Practice Location Address
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Address Line | 6116 ROLLING RD SUITE 116
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1521
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Country | US
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Telephone | 571-216-5467
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Fax | 703-866-7077
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Provider Business Mailing Address
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Address Line | 6116 ROLLING RD SUITE 116
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1521
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Country | US
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Telephone | 571-216-5467
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Fax | 703-866-7077
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Authorized Official
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Title or Position | OWNER
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Name | TON Q HO
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Credential |
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Telephone | 571-216-5467
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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 | 0103301168
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License Number State | VA
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