MEDICARE: DR. MARK EDWARD WINTERSTEEN D.P.M.

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	SC004446R	PA
2	213EP1101X	Primary Podiatric Medicine Podiatrist	SC004446R	PA
3	213ES0131X	Foot Surgery Podiatrist	SC004446R	PA

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	:	1578530671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK EDWARD WINTERSTEEN D.P.M.

Provider Business Mailing Address
First Line	:	36 RED HILL CT
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-8706
Country	:	US
Telephone Number	:	717-567-9100
Fax Number	:	717-567-7121

Provider Business Practice Location Address
First Line	:	36 RED HILL CT
Second Line	:
City	:	NEWPORT
State	:	PA
Zip	:	17074-8706
Country	:	US
Telephone Number	:	717-567-9100
Fax Number	:	717-567-7121

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	03/18/2014

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