Provider Demographics
NPI:1326469834
Name:ADVANCED FOOT AND ANKLE ASSOCIATES OF NORTHWESTERN PENNSYLVANIA PC
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE ASSOCIATES OF NORTHWESTERN PENNSYLVANIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-371-0300
Mailing Address - Street 1:207 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2517
Mailing Address - Country:US
Mailing Address - Phone:814-371-0300
Mailing Address - Fax:814-371-5000
Practice Address - Street 1:207 BEAVER DR
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2517
Practice Address - Country:US
Practice Address - Phone:814-371-0300
Practice Address - Fax:814-371-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004334L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008549OtherMEDICARE PTAN
PA0017114190002Medicaid
PAU70639Medicare UPIN