MEDICARE: STEVAN J ANSELMI 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	SC001853L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	442480314	OTHER	PA	TRAVELERS MEDICARE

General Provider Information

NPI Number	:	1336135458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVAN J ANSELMI DPM

Provider Business Mailing Address
First Line	:	103 WEST AVE
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1358
Country	:	US
Telephone Number	:	570-724-5297
Fax Number	:	570-724-8793

Provider Business Practice Location Address
First Line	:	103 WEST AVE
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-1358
Country	:	US
Telephone Number	:	570-724-5297
Fax Number	:	570-724-8793

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	10/12/2007

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