Basic Information
| Provider Information | |||||||||
| NPI: | 1841465291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DULLES FOOT ANKLE INSTITUTE, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 616 | ||||||||
| Address2: | |||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201460616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034432000 | ||||||||
| FaxNumber: | 7034432033 | ||||||||
| Practice Location | |||||||||
| Address1: | 224A CORNWALL ST NW | ||||||||
| Address2: | LOUDOUN COMMUNITY HEALTH CENTER | ||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201762701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034432120 | ||||||||
| FaxNumber: | 7034432033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2008 | ||||||||
| LastUpdateDate: | 01/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | MEHUL | ||||||||
| AuthorizedOfficialMiddleName: | JITENDRA | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPIERTOR | ||||||||
| AuthorizedOfficialTelephone: | 7034432000 | ||||||||
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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 | 0103300893 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 350392 | 01 | VA | ANTHEM BC/BS | OTHER | 3854800 | 01 | VA | CIGNA | OTHER | 7980784 | 01 | AETNA | OTHER | 2907018 | 01 | VA | UNITED HEALTHCARE | OTHER | J4630001 | 01 | VA | CAREFIRST BC/BS | OTHER |