Healthcare Provider Details

I. General information

NPI: 1053304360
Provider Name (Legal Business Name): ANTHONY CHARLES SOTTILE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 WALNUT ST
COLUMBIA PA
17512-1220
US

IV. Provider business mailing address

627 WALNUT ST
COLUMBIA PA
17512-1220
US

V. Phone/Fax

Practice location:
  • Phone: 717-684-2648
  • Fax: 717-684-7989
Mailing address:
  • Phone: 717-684-2648
  • Fax: 717-684-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC002502L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: