Provider Demographics
NPI:1306938543
Name:RONALD M. LANDESS DPM, PC
Entity type:Organization
Organization Name:RONALD M. LANDESS DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:LANDESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:804-282-6576
Mailing Address - Street 1:5700 OLD RICHMOND AVE STE E24
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-282-6576
Mailing Address - Fax:804-282-5223
Practice Address - Street 1:5700 OLD RICHMOND AVE STE E24
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-282-6576
Practice Address - Fax:804-282-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000605213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACL1054Medicare PIN
VAC01747Medicare PIN
VACL5094Medicare PIN
VAC03455Medicare PIN