Provider Demographics
NPI:1497759336
Name:CORTESE, GARY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:CORTESE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:48 TUNNEL RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3875
Mailing Address - Country:US
Mailing Address - Phone:570-622-0473
Mailing Address - Fax:570-624-4116
Practice Address - Street 1:1626 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2230
Practice Address - Fax:570-622-5724
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC002264L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012668300003Medicaid
PAT72806Medicare UPIN
PA0012668300003Medicaid