Provider Demographics
NPI:1053304360
Name:SOTTILE, ANTHONY CHARLES (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:SOTTILE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:PA
Mailing Address - Zip Code:17512-1220
Mailing Address - Country:US
Mailing Address - Phone:717-684-2648
Mailing Address - Fax:717-684-7989
Practice Address - Street 1:627 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:PA
Practice Address - Zip Code:17512-1220
Practice Address - Country:US
Practice Address - Phone:717-684-2648
Practice Address - Fax:717-684-7989
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002502L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12491OtherH/AM/H/ASSUR
01541001OtherBL/CR
992157OtherKEYSTONE
T28561Medicare UPIN
12491OtherH/AM/H/ASSUR