=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467826107
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNT CARMEL FAMILY FOOT CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2015
-----------------------------------------------------
Last Update Date | 12/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 W 2ND ST
-----------------------------------------------------
City | MOUNT CARMEL
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17851-1354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-5024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 CRESTMONT CIR
-----------------------------------------------------
City | BLOOMSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17815-7706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-339-5024
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PODIATRIST
-----------------------------------------------------
Name | DR. CAROLINE G. IGLIO
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 215-205-6830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP1100X
-----------------------------------------------------
Taxonomy Name | Podiatric Clinic/Center
-----------------------------------------------------
License Number | SC006059
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------