Provider Demographics
NPI:1346276862
Name:ADVANCED FOOT AND ANKLE ASSOC NWPA
Entity Type:Organization
Organization Name:ADVANCED FOOT AND ANKLE ASSOC NWPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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:814-772-3338
Mailing Address - Street 1:PO BOX 560
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-0560
Mailing Address - Country:US
Mailing Address - Phone:814-772-3338
Mailing Address - Fax:
Practice Address - Street 1:123 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853-2008
Practice Address - Country:US
Practice Address - Phone:814-772-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1538616OtherUMWA
PACH1507OtherRRMC
PA342217OtherPABS
PA0017812350002Medicaid
PA342217OtherPABS