Healthcare Provider Details

I. General information

NPI: 1922067958
Provider Name (Legal Business Name): BEECH TREE PODIATRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1546 E MARKET ST
YORK PA
17403-1255
US

IV. Provider business mailing address

1546 E MARKET ST
YORK PA
17403-1255
US

V. Phone/Fax

Practice location:
  • Phone: 717-843-0896
  • Fax: 717-854-6519
Mailing address:
  • Phone: 717-843-0896
  • Fax: 717-854-6519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. FRED DON CHANTILES
Title or Position: PRESIDENT
Credential: DPM
Phone: 717-843-0896