Provider Demographics
NPI:1427464726
Name:ACTIVE FOOT AND ANKLE CENTER, PC
Entity type:Organization
Organization Name:ACTIVE FOOT AND ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNJED
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-547-0123
Mailing Address - Street 1:369 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5309
Mailing Address - Country:US
Mailing Address - Phone:757-547-0123
Mailing Address - Fax:757-547-2412
Practice Address - Street 1:369 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5309
Practice Address - Country:US
Practice Address - Phone:757-547-0123
Practice Address - Fax:757-547-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-08
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301108332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies