Provider Demographics
NPI:1033193487
Name:LAUREL PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:LAUREL PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-832-7880
Mailing Address - Street 1:235 HUMPHREY ROAD
Mailing Address - Street 2:TWO PINEVIEW PLACE SUITE 4
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-832-7880
Mailing Address - Fax:724-832-8172
Practice Address - Street 1:235 HUMPHREY ROAD
Practice Address - Street 2:TWO PINEVIEW PLACE SUITE 4
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-7880
Practice Address - Fax:724-832-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002372L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008884420001Medicaid
PA413676MVAMedicare ID - Type Unspecified
PA0008884420001Medicaid