Provider Demographics
NPI:1194932566
Name:A TO Z FAMILY FOOTCARE
Entity type:Organization
Organization Name:A TO Z FAMILY FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-561-8671
Mailing Address - Street 1:12695 MCMANUS BLVD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4435
Mailing Address - Country:US
Mailing Address - Phone:757-561-8671
Mailing Address - Fax:757-968-5445
Practice Address - Street 1:12695 MCMANUS BLVD
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602
Practice Address - Country:US
Practice Address - Phone:757-561-8671
Practice Address - Fax:757-873-1448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300820213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA184314OtherANTHEM BLUE CROSS
VA690803OtherUNITED HEALTH CARE
VA1098304OtherAETNA HMO
VA1850407OtherTHE FIRST HEALTH NETWORK
VA0054716OtherCIGNA
VA7870748OtherAETNA PPO
VA1850407OtherTHE FIRST HEALTH NETWORK
VAU84246Medicare UPIN