Provider Demographics
NPI:1174590186
Name:PINSKY, MARC JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:PINSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1853
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-0853
Mailing Address - Country:US
Mailing Address - Phone:804-732-6000
Mailing Address - Fax:804-861-6558
Practice Address - Street 1:3333 S CRATER RD
Practice Address - Street 2:SUITE 3E
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9276
Practice Address - Country:US
Practice Address - Phone:804-732-6000
Practice Address - Fax:804-861-6885
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000414213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0165470001Medicare NSC
VAT21529Medicare UPIN