Provider Demographics
NPI:1093850422
Name:WEST BRANCH PODIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:WEST BRANCH PODIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-326-1400
Mailing Address - Street 1:1140 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3618
Mailing Address - Country:US
Mailing Address - Phone:570-326-1400
Mailing Address - Fax:570-326-2505
Practice Address - Street 1:1140 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3618
Practice Address - Country:US
Practice Address - Phone:570-326-1400
Practice Address - Fax:570-326-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002714L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA116973Medicare ID - Type UnspecifiedGROUP PROVIDER ID NUMBER