Provider Demographics
NPI:1437400686
Name:COLLEGEVILLE PODIATRY ASSOCIATES LLC
Entity Type:Organization
Organization Name:COLLEGEVILLE PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:UMERES
Authorized Official - Last Name:SOLIMEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:866-528-8767
Mailing Address - Street 1:924 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1525
Mailing Address - Country:US
Mailing Address - Phone:610-838-7942
Mailing Address - Fax:
Practice Address - Street 1:500 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 1020
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1353
Practice Address - Country:US
Practice Address - Phone:866-528-8767
Practice Address - Fax:866-528-8767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006006213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA181929YKGVMedicare UPIN