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Organization
RICHMOND FOOT CLINIC P.A.
Active
Organization
RICHMOND FOOT CLINIC P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRFATTAH MIRIAN D.P.M. (PRESIDENT)
(910) 997-3779
Entity
Organization
Contact information
Practice address
721 S LONG DR, ROCKINGHAM, NC 28379-4315
(910) 997-3779
(910) 997-7433
Mailing address
721 S LONG DR, ROCKINGHAM, NC 28379-4315
(910) 997-3779
(910) 997-7433
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
250
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0812A
BLUECROSS BLUESHIELD
—
01
—
480032821
RAILROAD MEDICARE
—
05
—
890812A
—
NC
Enumeration date
03/22/2007
Last updated
06/15/2010
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