Healthcare Provider Details

I. General information

NPI: 1275538365
Provider Name (Legal Business Name): ALAN C SALLY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631A NATIONAL PIKE E
BROWNSVILLE PA
15417
US

IV. Provider business mailing address

631A NATIONAL PIKE E
BROWNSVILLE PA
15417-9603
US

V. Phone/Fax

Practice location:
  • Phone: 724-785-8060
  • Fax: 724-785-6217
Mailing address:
  • Phone: 724-785-8060
  • Fax: 724-785-6217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC002363L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: