Healthcare Provider Details

I. General information

NPI: 1740269596
Provider Name (Legal Business Name): CENTRAL PA PODIATRY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BEALE AVE SUITE A
ALTOONA PA
16601-1705
US

IV. Provider business mailing address

2727 BEALE AVE SUITE A
ALTOONA PA
16601-1705
US

V. Phone/Fax

Practice location:
  • Phone: 814-946-1075
  • Fax: 814-946-4076
Mailing address:
  • Phone: 814-946-1075
  • Fax: 814-946-4076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DONALD E MRDJENOVICH
Title or Position: PRESIDENT
Credential: DPM
Phone: 814-946-1075