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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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