MEDICARE: DR. ANTHONY CHARLES SOTTILE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	SC002502L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	12491	OTHER	H/AM/H/ASSUR
2	01541001	OTHER	BL/CR
3	992157	OTHER	KEYSTONE

General Provider Information

NPI Number	:	1053304360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY CHARLES SOTTILE DPM

Provider Business Mailing Address
First Line	:	627 WALNUT ST
Second Line	:
City	:	COLUMBIA
State	:	PA
Zip	:	17512-1220
Country	:	US
Telephone Number	:	717-684-2648
Fax Number	:	717-684-7989

Provider Business Practice Location Address
First Line	:	627 WALNUT ST
Second Line	:
City	:	COLUMBIA
State	:	PA
Zip	:	17512-1220
Country	:	US
Telephone Number	:	717-684-2648
Fax Number	:	717-684-7989

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	07/08/2007

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