Provider Demographics
NPI:1467411041
Name:PENN NORTH CENTERS FOR ADVANCED WOUND CARE INC
Entity Type:Organization
Organization Name:PENN NORTH CENTERS FOR ADVANCED WOUND CARE INC
Other - Org Name:PENN NORTH PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SERENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-452-7878
Mailing Address - Street 1:232 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:814-452-7878
Mailing Address - Fax:
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-7878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENN NORTH CENTERS FOR ADVANCED WOUND CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-21
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty