MEDICARE: REGIONAL FOOT & ANKLE CENTER 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	213ES0103X	Foot & Ankle Surgery Podiatrist

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

General Provider Information

NPI Number	:	1487826905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL FOOT & ANKLE CENTER PC

Provider Business Mailing Address
First Line	:	1000 MEADE ST STE 201
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-3197
Country	:	US
Telephone Number	:	570-963-1974
Fax Number	:	570-963-0762

Provider Business Practice Location Address
First Line	:	1000 MEADE ST STE 201
Second Line	:
City	:	DUNMORE
State	:	PA
Zip	:	18512-3197
Country	:	US
Telephone Number	:	570-963-1974
Fax Number	:	570-963-0762

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELMO WILLIAM BALDASSARI JR.
Credential	:	DPM
Telephone Number	:	570-963-1974

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	06/04/2026

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