Provider Demographics
NPI:1164528402
Name:CHELTENHAM FOOT AND ANKLE
Entity Type:Organization
Organization Name:CHELTENHAM FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS-WATTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-635-3656
Mailing Address - Street 1:1801 W CHELTENHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1049
Mailing Address - Country:US
Mailing Address - Phone:215-635-3656
Mailing Address - Fax:215-635-1220
Practice Address - Street 1:1801 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1049
Practice Address - Country:US
Practice Address - Phone:215-635-3656
Practice Address - Fax:215-635-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO4426L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty