MEDICARE: PAUL C LAFATA D.P.M.

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	SC004661-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1462377	OTHER	PA	HIGHMARK BLUE SHIELD
2	50015444	OTHER	PA	CAPITAL BLUE CROSS
3	P00203039	OTHER	PA	PALMETTO GBA

General Provider Information

NPI Number	:	1790785947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL C LAFATA D.P.M.

Provider Business Mailing Address
First Line	:	25 STEVENS AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1424
Country	:	US
Telephone Number	:	610-678-4581
Fax Number	:	610-678-8677

Provider Business Practice Location Address
First Line	:	25 STEVENS AVE
Second Line	:
City	:	WEST LAWN
State	:	PA
Zip	:	19609-1424
Country	:	US
Telephone Number	:	610-678-4581
Fax Number	:	610-678-8677

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/05/2010

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Directions to “ PAUL C LAFATA D.P.M.” Practice Location

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