Healthcare Provider Details

I. General information

NPI: 1851877179
Provider Name (Legal Business Name): ANDREW MERMELSTEIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/10/2022
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 COTTMAN AVE STE A
PHILADELPHIA PA
19111-3728
US

IV. Provider business mailing address

1337 COTTMAN AVE STE A
PHILADELPHIA PA
19111-3728
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-6566
  • Fax: 215-893-1722
Mailing address:
  • Phone: 152-745-6566
  • Fax: 215-893-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberSC006928
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006928
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC006928
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberSC006928
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC006928
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberSC006928
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006928
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: