Provider Demographics
NPI:1093755936
Name:PELLECCHIA, EDWARD J (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:PELLECCHIA
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 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-9338
Mailing Address - Fax:215-947-8407
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 105
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-9338
Practice Address - Fax:215-947-8407
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003280L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0413304000OtherINDEPENDENCE BLUE CROSS
PA0004114916OtherAETNA
PA0012055400004Medicaid
U20625Medicare UPIN
PA0012055400004Medicaid