Provider Demographics
NPI:1316184518
Name:MID-ATLANTIC FOOTCARE
Entity type:Organization
Organization Name:MID-ATLANTIC FOOTCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-963-8868
Mailing Address - Street 1:1401 TIDEWATER DR STE 1
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-2840
Mailing Address - Country:US
Mailing Address - Phone:757-963-8868
Mailing Address - Fax:757-963-8867
Practice Address - Street 1:1401 TIDEWATER DR STE 1
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-2840
Practice Address - Country:US
Practice Address - Phone:757-963-8868
Practice Address - Fax:757-963-8867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2009-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000848213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty