Healthcare Provider Details

I. General information

NPI: 1073502076
Provider Name (Legal Business Name): MICHAEL SCOTT DOWNEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MARKET ST MAB # 111
PHILADELPHIA PA
19104-3153
US

IV. Provider business mailing address

3801 MARKET ST MAB # 111
PHILADELPHIA PA
19104-3153
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9563
  • Fax: 215-243-8818
Mailing address:
  • Phone: 215-662-9563
  • Fax: 215-243-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberSC002981L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC002981L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC002981L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: