1093741126 NPI number — CHESTNUT HILL PODIATRY ASSOCIATES,P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093741126 NPI number — CHESTNUT HILL PODIATRY ASSOCIATES,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTNUT HILL PODIATRY ASSOCIATES,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093741126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8815 GERMANTOWN AVE
Provider Second Line Business Mailing Address:
SUITE 11
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19118-2722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-247-0879
Provider Business Mailing Address Fax Number:
215-247-7014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8815 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-0879
Provider Business Practice Location Address Fax Number:
215-247-7014
Provider Enumeration Date:
06/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCANLON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-247-0879

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1007530500003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".