MEDICARE: JOSEPH CHARLES DICKINSON JR. DPM

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
1	213E00000X	Podiatrist	SC003089L	PA
2	213E00000X	Podiatrist	MD01795	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164473427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CHARLES DICKINSON JR. DPM

Provider Business Mailing Address
First Line	:	1426 W ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1714
Country	:	US
Telephone Number	:	215-228-2800
Fax Number	:	215-228-2050

Provider Business Practice Location Address
First Line	:	1426 W ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-1714
Country	:	US
Telephone Number	:	215-228-2800
Fax Number	:	215-228-2050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	04/06/2011

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