MEDICARE: ALLAN SCOTT WAX 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	213ES0103X	Foot & Ankle Surgery Podiatrist	0103000780	VA

General Provider Information

NPI Number	:	1609834795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLAN SCOTT WAX DPM

Provider Business Mailing Address
First Line	:	13000 RIVERS BEND BLVD
Second Line	:	SUITE D
City	:	CHESTER
State	:	VA
Zip	:	23836-8632
Country	:	US
Telephone Number	:	804-571-5106
Fax Number	:	804-530-3015

Provider Business Practice Location Address
First Line	:	13048 RIVERS BEND RD
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23836-2564
Country	:	US
Telephone Number	:	804-526-5888
Fax Number	:	804-526-5401

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	12/05/2017

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