Provider Demographics
NPI:1548642788
Name:PHILLINGANE, JUSTIN ANDREW (DPM)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANDREW
Last Name:PHILLINGANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-722-8860
Mailing Address - Fax:804-722-8861
Practice Address - Street 1:3335 S CRATER RD STE 500
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805
Practice Address - Country:US
Practice Address - Phone:804-722-8860
Practice Address - Fax:804-722-8861
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR423390200000X
VA0103301225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program