Provider Demographics
NPI:1427260751
Name:CHANTILLY FOOT AND ANKLE CENTER ,LLC
Entity type:Organization
Organization Name:CHANTILLY FOOT AND ANKLE CENTER ,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BATHAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-490-5599
Mailing Address - Street 1:PO BOX 220734
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-0734
Mailing Address - Country:US
Mailing Address - Phone:703-490-5599
Mailing Address - Fax:
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 308
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:703-490-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300742213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIC09005Medicare ID - Type Unspecified