Provider Demographics
NPI:1083686034
Name:BOSTA, STANLEY D (DPM)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:BOSTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:D
Other - Last Name:BOSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, PC
Mailing Address - Street 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE 230
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-325-0397
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:495 WATERFRONT DR E
Practice Address - Street 2:SUITE 230
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1140
Practice Address - Country:US
Practice Address - Phone:412-325-0397
Practice Address - Fax:412-461-5490
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001840L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1710912845OtherGROUP NPI
PA1382437OtherHIGHMARK GROUP NUMBER
PA1156610001OtherDMERC PROVIDER NUMBER
PA0005069140004Medicaid
PA1015184OtherGATEWAY HMO PROV NUMBER
PA63793OtherHIGHMARK INDIVIDUAL PROV#
PA0004303232OtherAETNA PIN
PA1710912845OtherRR MEDICARE GROUP NPI
PA1205011277OtherDMERC NPI
PA1382437OtherHIGHMARK GROUP NUMBER
PA1710912845OtherRR MEDICARE GROUP NPI