Provider Demographics
NPI:1841465291
Name:DULLES FOOT ANKLE INSTITUTE, PLC
Entity type:Organization
Organization Name:DULLES FOOT ANKLE INSTITUTE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPIERTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHUL
Authorized Official - Middle Name:JITENDRA
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-443-2000
Mailing Address - Street 1:PO BOX 616
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20146-0616
Mailing Address - Country:US
Mailing Address - Phone:703-443-2000
Mailing Address - Fax:703-443-2033
Practice Address - Street 1:224A CORNWALL ST NW
Practice Address - Street 2:LOUDOUN COMMUNITY HEALTH CENTER
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2701
Practice Address - Country:US
Practice Address - Phone:703-443-2120
Practice Address - Fax:703-443-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300893213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350392OtherANTHEM BC/BS
VA3854800OtherCIGNA
7980784OtherAETNA
VA2907018OtherUNITED HEALTHCARE
VAJ4630001OtherCAREFIRST BC/BS
C10518Medicare UPIN
7980784OtherAETNA
VA6126450001Medicare NSC