Organization
MANASSAS FOOT CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO M BENNETT DPM (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
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
09/17/2013
Last updated
09/17/2013
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