Healthcare Provider Details

I. General information

NPI: 1497810550
Provider Name (Legal Business Name): KEYSTONE PODIATRIC MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 SIR THOMAS COURT SUITE 2
HARRISBURG PA
17109
US

IV. Provider business mailing address

PO BOX 526
BIGLERVILLE PA
17307-0526
US

V. Phone/Fax

Practice location:
  • Phone: 717-652-5811
  • Fax: 717-541-1161
Mailing address:
  • Phone: 717-677-9288
  • Fax: 717-677-4196

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. RICHARD ALLEN ROGERS
Title or Position: PRESIDENT CORPORATION
Credential: DPM
Phone: 717-677-9288