Healthcare Provider Details

I. General information

NPI: 1356337489
Provider Name (Legal Business Name): JOHN ALBRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 05/24/2021
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W 9TH ST
BERWICK PA
18603-3024
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-759-1363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC001252L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: