Provider Demographics
NPI:1487762522
Name:RIBEIRO-BACHTELL, CARLA EMILIA (DPM)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:EMILIA
Last Name:RIBEIRO-BACHTELL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1535
Mailing Address - Country:US
Mailing Address - Phone:703-637-9917
Mailing Address - Fax:703-566-5201
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-637-9917
Practice Address - Fax:703-566-5201
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300837213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU96940Medicare UPIN