Healthcare Provider Details

I. General information

NPI: 1033211552
Provider Name (Legal Business Name): SPRINGFIELD PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 CHILDS AVE
DREXEL HILL PA
19026-3805
US

IV. Provider business mailing address

648 CHILDS AVE
DREXEL HILL PA
19026-3805
US

V. Phone/Fax

Practice location:
  • Phone: 484-521-0233
  • Fax: 484-521-0235
Mailing address:
  • Phone: 484-521-0233
  • Fax: 484-521-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC003867L
License Number StatePA

VIII. Authorized Official

Name: DR. JULIE B. SIEGERMAN
Title or Position: OWNER
Credential: D.P.M.
Phone: 484-521-0233