=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568424018
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERARD J. FOTI D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2006
-----------------------------------------------------
Last Update Date | 10/14/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 E HAVERFORD RD STE 202
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-558-1001
-----------------------------------------------------
Fax | 610-558-1180
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 931 E HAVERFORD RD STE 202
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-558-1001
-----------------------------------------------------
Fax | 610-558-1180
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | H0058007
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | OS009073L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------