Provider Demographics
NPI:1225005150
Name:QUARTEY, SAMUEL FERGUSON (DPM)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:FERGUSON
Last Name:QUARTEY
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 1:5023 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:215-471-1407
Mailing Address - Fax:215-471-6061
Practice Address - Street 1:5023 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-471-1407
Practice Address - Fax:215-471-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002081L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060592000OtherKEYSTONE EAST
PA0060692000OtherKEYSTONE 65
PA095915OtherBCBS
PA0540237Medicaid
PA0060692000OtherKEYSTONE 65
PA095915Medicare PIN