Provider Demographics
NPI:1568676773
Name:COVENTRY PODIATRY PC
Entity Type:Organization
Organization Name:COVENTRY PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LAPIC
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-326-9666
Mailing Address - Street 1:8 GLOCKER WAY
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19465-9649
Mailing Address - Country:US
Mailing Address - Phone:610-326-9666
Mailing Address - Fax:
Practice Address - Street 1:8 GLOCKER WAY
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19465-9649
Practice Address - Country:US
Practice Address - Phone:610-326-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002999L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112776Medicare PIN
PAT30206Medicare UPIN