Basic Information
| Provider Information | |||||||||
| NPI: | 1134102833 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOX MILL FOOT AND ANKLE CENTER PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033910211 | ||||||||
| FaxNumber: | 7032643983 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033910211 | ||||||||
| FaxNumber: | 7032643983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 10/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | RUBENSTEIN | ||||||||
| AuthorizedOfficialFirstName: | SETH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7033910211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
No ID Information.