MEDICARE: DR. KRISTIN KAYE GINGRICH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	0103300817	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	480030840	OTHER	VA	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	140044	OTHER	VA	ANTHEM PROVIDER ID
3	286847	OTHER	VA	MAMSI
4	130184	OTHER	VA	SOUTHERN HEALTH

General Provider Information

NPI Number	:	1164489837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIN KAYE GINGRICH DPM

Provider Business Mailing Address
First Line	:	5230 HICKORY PARK DR
Second Line	:	SUITE D
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2628
Country	:	US
Telephone Number	:	804-934-0661
Fax Number	:	804-934-0663

Provider Business Practice Location Address
First Line	:	5230 HICKORY PARK DR
Second Line	:	SUITE D
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2628
Country	:	US
Telephone Number	:	804-934-0661
Fax Number	:	804-934-0663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/28/2012

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