Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0103000921 | VA |
N | 222Z00000X | Podiatrist | 0103000921 | VA |
N | 213EP1101X | Primary Podiatric Medicine | 0103000921 | VA |
N | 111NR0200X | Radiology | 0103000921 | VA |
N | 213ER0200X | Radiology | 0103000921 | VA |
N | 2081S0010X | Sports Medicine | 0103000921 | VA |
N | 213ES0000X | Sports Medicine | 0103000921 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 0103000921 | VA |
Y | 213ES0131X | Foot Surgery | 0103000921 | VA |
NPI | 1437250370 |
---|---|
Provider Name | Angelo Pace |
First Address | Alexandria, VA 22310-3245 |
Second Address | Alexandria, VA 22310-3245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 17/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42353 | (02) | VA |