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General NPI Number Information
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NPI Number | 1972996189
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Entity Type | Organization
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Legal Business Name | BANGOR PODIATRY LLC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1310 ROUTE 209 STE 107
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City | GILBERT
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State | PA
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Zip | 18331-7751
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Country | US
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Telephone | 570-992-5779
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Fax | 570-992-5806
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Provider Business Mailing Address
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Address Line | 129 N 11TH ST
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City | BANGOR
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State | PA
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Zip | 18013-1603
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Country | US
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Telephone | 610-588-6621
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Fax | 610-588-6307
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Authorized Official
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Title or Position | OWNER
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Name | CHERALYN PERKINS
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Credential | DPM
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Telephone | 610-588-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC004468L
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License Number State | PA
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