Provider Demographics
NPI:1417990193
Name:BRYN MAWR FOOT & ANKLE CENTER, LLC
Entity Type:Organization
Organization Name:BRYN MAWR FOOT & ANKLE CENTER, LLC
Other - Org Name:BRYN MAWR FOOT & ANKLE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-527-8655
Mailing Address - Street 1:934 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2502
Mailing Address - Country:US
Mailing Address - Phone:610-527-8655
Mailing Address - Fax:610-527-8346
Practice Address - Street 1:934 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2502
Practice Address - Country:US
Practice Address - Phone:610-527-8655
Practice Address - Fax:610-527-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003800L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101657273 0001Medicaid
PA6169460001Medicare NSC
PA100284Medicare PIN