MEDICARE: NIGRO PODIATRY

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	213ES0103X	Foot & Ankle Surgery Podiatrist	SC003358L	PA
2	213ES0103X	Foot & Ankle Surgery Podiatrist	SC005745	PA
3	213ES0103X	Foot & Ankle Surgery Podiatrist	SC003276L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235164815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NIGRO PODIATRY

Provider Business Mailing Address
First Line	:	127 COLUMBIA AVE
Second Line	:
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690-1101
Country	:	US
Telephone Number	:	724-567-7520
Fax Number	:	724-568-2169

Provider Business Practice Location Address
First Line	:	127 COLUMBIA AVE
Second Line	:
City	:	VANDERGRIFT
State	:	PA
Zip	:	15690-1101
Country	:	US
Telephone Number	:	724-567-7520
Fax Number	:	724-568-2169

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFF NIGRO
Credential	:	D.P.M
Telephone Number	:	724-567-7520

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	11/01/2011

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Directions to “NIGRO PODIATRY ” Practice Location

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