Healthcare Provider Details

I. General information

NPI: 1023734365
Provider Name (Legal Business Name): MONTGOMERY PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 WELSH RD STE 103
HUNTINGDON VALLEY PA
19006-6357
US

IV. Provider business mailing address

602 BEECHWOOD RD
WILLOW GROVE PA
19090-1304
US

V. Phone/Fax

Practice location:
  • Phone: 215-938-7725
  • Fax: 215-938-7990
Mailing address:
  • Phone: 267-524-9436
  • Fax: 215-938-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ELIZABETH VARGHESE
Title or Position: OWNER
Credential: DPM
Phone: 267-524-9436