Provider Demographics
NPI:1104305754
Name:FAIRFAX FOOT AND ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:FAIRFAX FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-494-6958
Mailing Address - Street 1:10875 MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10875 MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4732
Practice Address - Country:US
Practice Address - Phone:203-494-6958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty