Provider Demographics
NPI:1235991233
Name:NERVOLOGY LOWER EXTREMITY OF PENNSYLVANIA
Entity Type:Organization
Organization Name:NERVOLOGY LOWER EXTREMITY OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTINDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:NAGRA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-228-9892
Mailing Address - Street 1:205 GRANDVIEW AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:404-228-9892
Mailing Address - Fax:
Practice Address - Street 1:205 GRANDVIEW AVE STE 206
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1708
Practice Address - Country:US
Practice Address - Phone:404-228-9892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty