Healthcare Provider Details

I. General information

NPI: 1619542917
Provider Name (Legal Business Name): ALLIED PODIATRIC AND VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 DEKALB PIKE
BLUE BELL PA
19422-1215
US

IV. Provider business mailing address

831 DEKALB PIKE
BLUE BELL PA
19422-1215
US

V. Phone/Fax

Practice location:
  • Phone: 267-405-9090
  • Fax: 215-240-1677
Mailing address:
  • Phone: 267-405-9090
  • Fax: 215-240-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMES MCGUCKIN
Title or Position: CEO
Credential: MD
Phone: 267-405-9090