Provider Demographics
NPI:1053651745
Name:DELTA FOOT AND ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:DELTA FOOT AND ANKLE CENTER, LLC
Other - Org Name:DAWN Y. STEIN DPM CWS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-458-6245
Mailing Address - Street 1:PO BOX 16008
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15242
Mailing Address - Country:US
Mailing Address - Phone:412-920-5860
Mailing Address - Fax:412-920-5861
Practice Address - Street 1:247 N BROAD STREET EXT
Practice Address - Street 2:SUITE 204
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127
Practice Address - Country:US
Practice Address - Phone:724-458-6245
Practice Address - Fax:724-458-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031160200002Medicaid