Provider Demographics
NPI:1245989920
Name:FOOT AND ANKLE MANAGEMENT OF VIRGINIA
Entity type:Organization
Organization Name:FOOT AND ANKLE MANAGEMENT OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURAEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:757-234-2905
Mailing Address - Street 1:1155 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-3329
Mailing Address - Country:US
Mailing Address - Phone:757-234-2905
Mailing Address - Fax:
Practice Address - Street 1:1155 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-3329
Practice Address - Country:US
Practice Address - Phone:757-234-2905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326018615OtherFOOT AND ANKLE SURGERY
VA1295193811OtherFOOT AND ANKLE SURGERY
VA1285823401OtherFOOT AND ANKLE SURGERY
VA1003926031OtherFOOT AND ANKLE SURGERY