MEDICARE: NORTH CENTRAL PENN PODIATRY PC

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	SC0018534	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CM5849	OTHER	PA	TRAVELERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	593990	OTHER		HIGHMARK BS

General Provider Information

NPI Number	:	1366435653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL PENN PODIATRY PC

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	:	OWNER
Name	:	STEVAN J ANSELMI
Credential	:	DPM
Telephone Number	:	570-724-5297

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/12/2007

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16901-1358

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1063588457 — WILLIAM DOUGLAS CHANCELLOR LCSW
Practice Location Address:

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1255497608 — EDWARD L SHOLONSKI
Practice Location Address:

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Directions to “NORTH CENTRAL PENN PODIATRY PC ” Practice Location

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