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General NPI Number Information
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NPI Number | 1295722874
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Entity Type | Individual
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Provider Name | ANGELO B SUTERA JR. DPM
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 280 N PROVIDENCE RD STE 103
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City | MEDIA
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State | PA
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Zip | 19063-3530
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Country | US
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Telephone | 610-566-4563
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Fax | 610-566-1856
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Provider Business Mailing Address
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Address Line | 280 N PROVIDENCE RD STE 103
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City | MEDIA
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State | PA
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Zip | 19063-3530
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Country | US
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Telephone | 610-566-4563
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Fax | 610-566-1856
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | SC003658L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC003658L
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License Number State | PA
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