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Organization
MANASSAS FOOT CLINIC INC
Active
Organization
MANASSAS FOOT CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO M. BENNETT D.P.M. (PRESIDENT)
(703) 361-3132
Entity
Organization
Contact information
Practice address
8704 ROLLING RD, MANASSAS, VA 20110-4253
(703) 361-3132
(703) 368-0291
Mailing address
8704 ROLLING RD, MANASSAS, VA 20110-4253
(703) 361-3132
(703) 368-0291
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0103001009
VA
213ES0131X
Foot Surgery Podiatrist
0103000268
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009300627
—
VA
01
—
035461
BLUE SHIELD
VA
01
—
21906
UNITEDHEALTHCARE
—
01
—
7134
CAREFIRST
—
Enumeration date
11/20/2006
Last updated
12/18/2012
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