Provider Demographics
NPI:1528650744
Name:EASTERN VIRGINIA FOOT AND ANKLE PLLC
Entity type:Organization
Organization Name:EASTERN VIRGINIA FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:YUN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-698-4177
Mailing Address - Street 1:109 WIMBLEDON SQ STE F
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4945
Mailing Address - Country:US
Mailing Address - Phone:757-979-4028
Mailing Address - Fax:
Practice Address - Street 1:109 WIMBLEDON SQ STE F
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4945
Practice Address - Country:US
Practice Address - Phone:757-979-4028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty