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NPI Code Detail

MEDICARE: PETER P SIDORIAK DPM

MEDICARE: PETER P SIDORIAK 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
1213E00000XPodiatristSC002367LPA
2213E00000XPodiatristPO0001394FL
3213E00000XPodiatrist0200AZ

Other Identifiers

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

General Provider Information

NPI Number : 1972569515
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER P SIDORIAK DPM
Provider Business Mailing Address
First Line : 1851 WEST END AVE
Second Line :
City : POTTSVILLE
State : PA
Zip : 17901-2050
Country : US
Telephone Number : 570-622-3668
Fax Number : 570-622-2920
Provider Business Practice Location Address
First Line : 1851 WEST END AVE
Second Line :
City : POTTSVILLE
State : PA
Zip : 17901-2050
Country : US
Telephone Number : 570-622-3668
Fax Number : 570-622-2920
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2006
Last Update Date : 11/15/2007

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Directions to “ PETER P SIDORIAK DPM” Practice Location

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