Provider Demographics
NPI:1033211552
Name:SPRINGFIELD PODIATRY LLC
Entity Type:Organization
Organization Name:SPRINGFIELD PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIEGERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-521-0233
Mailing Address - Street 1:648 CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3805
Mailing Address - Country:US
Mailing Address - Phone:484-521-0233
Mailing Address - Fax:484-521-0235
Practice Address - Street 1:648 CHILDS AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3805
Practice Address - Country:US
Practice Address - Phone:484-521-0233
Practice Address - Fax:484-521-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003867L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1329473OtherPA BLUE SHIELD
PA4299830001Medicare NSC
PA782525QD0Medicare PIN