Provider Demographics
NPI:1346540515
Name:ALL AMERICAN PODIATRY AND WOUND CARE, P.C.
Entity type:Organization
Organization Name:ALL AMERICAN PODIATRY AND WOUND CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-499-8098
Mailing Address - Street 1:4620 BUNKER HILL LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2245
Mailing Address - Country:US
Mailing Address - Phone:757-499-8098
Mailing Address - Fax:757-440-3515
Practice Address - Street 1:4620 BUNKER HILL LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2245
Practice Address - Country:US
Practice Address - Phone:757-499-8098
Practice Address - Fax:757-440-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001054213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009304533Medicaid
VA009304533Medicaid
VAU74490Medicare UPIN