MEDICARE: COMPREHENSIVE FOOT AND ANKLE CENTER,PA

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	213ES0103X	Foot & Ankle Surgery Podiatrist	413	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D02704	OTHER	NC	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356524037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE FOOT AND ANKLE CENTER,PA

Provider Business Mailing Address
First Line	:	1928 RANDOLPH ROAD
Second Line	:	SUITE 214
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1105
Country	:	US
Telephone Number	:	704-332-5115
Fax Number	:	704-332-5116

Provider Business Practice Location Address
First Line	:	1928 RANDOLPH RD
Second Line	:	SUITE 214
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1105
Country	:	US
Telephone Number	:	704-562-6384
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ZACHARY J NELLAS
Credential	:	DPM
Telephone Number	:	704-562-6384

Provider Enumeration Date	:	12/17/2007
Last Update Date	:	01/26/2010

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Directions to “COMPREHENSIVE FOOT AND ANKLE CENTER,PA ” Practice Location

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