1447221387 NPI number — MARTIN PODIATRY PC

Table of content: (NPI 1447221387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447221387 NPI number — MARTIN PODIATRY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN PODIATRY PC
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:
MARTIN FOOT AND ANKLE
Provider Other Organization Name Type Code:
3
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:
1447221387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 PLEASANT VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17402-9627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-757-3537
Provider Business Mailing Address Fax Number:
717-718-8674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 PLEASANT VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17402-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-757-3537
Provider Business Practice Location Address Fax Number:
717-718-8674
Provider Enumeration Date:
01/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUNKERLEY
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
717-757-3537

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000886920007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".