Provider Demographics
NPI:1245427301
Name:TRI-STATE PODIATRY ASSOCIATES,PA
Entity Type:Organization
Organization Name:TRI-STATE PODIATRY ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP. PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-475-5285
Mailing Address - Street 1:2217 OLD ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4153
Mailing Address - Country:US
Mailing Address - Phone:302-475-5285
Mailing Address - Fax:
Practice Address - Street 1:2217 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4153
Practice Address - Country:US
Practice Address - Phone:302-475-5285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000060213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1871644708Medicaid
DE555004Medicare PIN