Provider Demographics
NPI:1336298124
Name:PENNSYLVANIA FOOT AND ANKLE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PENNSYLVANIA FOOT AND ANKLE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-980-8663
Mailing Address - Street 1:1304 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2870
Mailing Address - Country:US
Mailing Address - Phone:215-742-1225
Mailing Address - Fax:215-742-3902
Practice Address - Street 1:1304 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-742-1225
Practice Address - Fax:215-742-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC006158213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001829025-0001Medicaid
PA001829025-0010Medicaid
PA001829025-0011Medicaid
PA001829025-0012Medicaid
PAT28187Medicare UPIN
T27068Medicare UPIN
T29522Medicare UPIN