Healthcare Provider Details

I. General information

NPI: 1467998435
Provider Name (Legal Business Name): EXETER FOOT & ANKLE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2017
Last Update Date: 05/03/2020
Certification Date: 05/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEARTHSTONE CT STE 106
READING PA
19606-3062
US

IV. Provider business mailing address

6 HEARTHSTONE CT STE 106
READING PA
19606-3062
US

V. Phone/Fax

Practice location:
  • Phone: 610-779-3643
  • Fax: 610-779-3841
Mailing address:
  • Phone: 610-779-3643
  • Fax: 610-779-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License NumberSC004439L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberSC004439L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberSC004439L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberSC004439L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004439L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC004439L
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC004439L
License Number StatePA

VIII. Authorized Official

Name: RANDY SMARGIASSI
Title or Position: OWNER
Credential: DPM
Phone: 484-797-8075