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NPI Code Detail

MEDICARE: GPHA PODIATRY SERVICES

MEDICARE: GPHA PODIATRY SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist

General Provider Information

NPI Number : 1144246232
Entity Type Code : Organization
Provider Name (Legal Business Name) : GPHA PODIATRY SERVICES
Provider Business Mailing Address
First Line : 432 N 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19123-4004
Country : US
Telephone Number : 215-925-2400
Fax Number :
Provider Business Practice Location Address
First Line : 4510 FRANKFORD AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19124-3602
Country : US
Telephone Number : 215-744-1302
Fax Number :
Authorized Official
Title or Position : MANAGED CARE COORDINATOR
Name : MIXZA SANTA
Credential :
Telephone Number : 215-925-2400
Provider Enumeration Date : 07/14/2006
Last Update Date : 08/22/2020

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Directions to “GPHA PODIATRY SERVICES ” Practice Location

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