Provider Demographics
NPI:1407828825
Name:SMARGIASSI, RANDY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MICHAEL
Last Name:SMARGIASSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEARTHSTONE CT STE 106
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3062
Mailing Address - Country:US
Mailing Address - Phone:610-779-3643
Mailing Address - Fax:610-779-3841
Practice Address - Street 1:6 HEARTHSTONE CT STE 106
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3062
Practice Address - Country:US
Practice Address - Phone:610-779-3643
Practice Address - Fax:610-779-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004439L213ES0131X, 213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102002670-0004Medicaid
PA120972LRQMedicare PIN