Provider Demographics
NPI:1083909337
Name:WEST CHESTER PODIATRY, LLC
Entity Type:Organization
Organization Name:WEST CHESTER PODIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:513-779-9673
Mailing Address - Street 1:8746 UNION CENTRE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4876
Mailing Address - Country:US
Mailing Address - Phone:513-779-9673
Mailing Address - Fax:513-779-3452
Practice Address - Street 1:8746 UNION CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4876
Practice Address - Country:US
Practice Address - Phone:513-779-9673
Practice Address - Fax:513-779-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3603391213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3009041Medicaid
4143741Medicare PIN
OHV01575Medicare UPIN