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General NPI Number Information
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NPI Number | 1982890943
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Entity Type | Organization
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Legal Business Name | ADVANCED PACE FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 2616 SHERWOOD HALL LN STE 401
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3154
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Country | US
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Telephone | 703-360-9292
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Fax | 703-360-5983
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Provider Business Mailing Address
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Address Line | 2616 SHERWOOD HALL LN STE 401
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3154
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Country | US
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Telephone | 703-360-9292
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Fax | 703-360-5983
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANGELO PACE
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Credential | D.P.M.
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Telephone | 703-360-9292
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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 | 0103300837
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0103000921
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License Number State | VA
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