Provider Demographics
NPI:1508027806
Name:PODIATRY ASSOCIATES OF JAMESTOWN
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF JAMESTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:TUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-483-2200
Mailing Address - Street 1:73 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2507
Mailing Address - Country:US
Mailing Address - Phone:814-726-3668
Mailing Address - Fax:814-726-3669
Practice Address - Street 1:73 MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2507
Practice Address - Country:US
Practice Address - Phone:814-726-3668
Practice Address - Fax:814-726-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002911L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0493780002Medicare NSC