# RICHMOND FOOT CLINIC P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043337595
- **Authorized official:** DR. MIRFATTAH MIRIAN D.P.M. (PRESIDENT)
- **Authorized official phone:** (910) 997-3779

## Contact information

- **Practice address:** 721 S LONG DR, ROCKINGHAM, NC 28379-4315
- **Practice address phone:** (910) 997-3779
- **Practice address fax:** (910) 997-7433
- **Mailing address:** 721 S LONG DR, ROCKINGHAM, NC 28379-4315
- **Mailing address phone:** (910) 997-3779
- **Mailing address fax:** (910) 997-7433

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 250 | NC | Yes |

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 06/15/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0812A | BLUECROSS BLUESHIELD | — |
| 01 | — | 480032821 | RAILROAD MEDICARE | — |
| 05 | — | 890812A | — | NC |