Healthcare Provider Details

I. General information

NPI: 1811978844
Provider Name (Legal Business Name): KEVIN TODD NAUGLE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 PHILADELPHIA AVE
SHILLINGTON PA
19607-2769
US

IV. Provider business mailing address

654 PHILADELPHIA AVE
SHILLINGTON PA
19607-2769
US

V. Phone/Fax

Practice location:
  • Phone: 610-796-9522
  • Fax: 610-796-0105
Mailing address:
  • Phone: 610-796-9522
  • Fax: 610-796-0105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC-003451-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: