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NPI Code Detail

MEDICARE: CENTRAL PA PODIATRY LLC

MEDICARE: CENTRAL PA PODIATRY LLC
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
1213E00000XPodiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11902884950OTHERPADR. GERALD GRONBORG
21487632428OTHERPADR. DONALD MRDJENOVICH
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841887494
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL PA PODIATRY LLC
Provider Business Mailing Address
First Line : 914 S 12TH ST
Second Line :
City : ALTOONA
State : PA
Zip : 16602-6247
Country : US
Telephone Number : 814-201-2309
Fax Number : 814-201-2389
Provider Business Practice Location Address
First Line : 914 S 12TH ST
Second Line :
City : ALTOONA
State : PA
Zip : 16602-6247
Country : US
Telephone Number : 814-201-2309
Fax Number : 814-201-2389
Authorized Official
Title or Position : PRACTICE MANAGER
Name : DENISE BARANIK
Credential :
Telephone Number : 814-201-2309
Provider Enumeration Date : 12/30/2020
Last Update Date : 12/30/2020

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1003302068 — DR. JACOB CARMICHAEL DPM
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Directions to “CENTRAL PA PODIATRY LLC ” Practice Location

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