Healthcare Provider Details

I. General information

NPI: 1629160130
Provider Name (Legal Business Name): ANTHONY WAYNE NORRIS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 HOSPITAL DR
TOWANDA PA
18848-9702
US

IV. Provider business mailing address

71 HOSPITAL DRIVE
TOWANDA PA
18848-9706
US

V. Phone/Fax

Practice location:
  • Phone: 570-265-6300
  • Fax: 570-268-2807
Mailing address:
  • Phone: 570-265-6300
  • Fax: 570-268-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC005580
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: