Provider Demographics
NPI:1427105949
Name:1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
Entity type:Organization
Organization Name:1FOOT 2FOOT CENTRE FOR FOOT AND ANKLE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:DAIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, FACFAS
Authorized Official - Phone:757-934-0768
Mailing Address - Street 1:171 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4507
Mailing Address - Country:US
Mailing Address - Phone:757-934-0768
Mailing Address - Fax:757-925-1901
Practice Address - Street 1:171 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-934-0768
Practice Address - Fax:757-925-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300887213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010316057Medicaid
VA010316057Medicaid
VAC10073Medicare PIN
VA6006250001Medicare NSC