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Organization
FOOT & ANKLE CLINIC OF SOUTH BOSTON PC
Active
Organization
FOOT & ANKLE CLINIC OF SOUTH BOSTON PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ALAN MARVIN DPM (OWNER OPERATOR)
(434) 572-1444
Entity
Organization
Contact information
Practice address
405 A OAK LANE, SOUTH BOSTON, VA 24592
(434) 572-1444
(434) 575-8159
Mailing address
405 A OAK LANE, SOUTH BOSTON, VA 24592-1633
(434) 572-1444
(434) 575-8159
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
0103000792
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
480021195
RAILROAD
—
01
—
VAA102502
MEDICARE PTAN
VA
Enumeration date
06/11/2006
Last updated
11/12/2014
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