Provider Demographics
NPI:1578535159
Name:ADVANCED PODIATRY ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:ADVANCED PODIATRY ASSOCIATES, LLC.
Other - Org Name:ADVANCED PODIATRY ASSOCIATES, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-262-3417
Mailing Address - Street 1:1356 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-1612
Mailing Address - Country:US
Mailing Address - Phone:610-262-3417
Mailing Address - Fax:
Practice Address - Street 1:1356 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1612
Practice Address - Country:US
Practice Address - Phone:610-262-3417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA414134OtherHIGHMARK
PA0181357000OtherKEYSTONE EAST
PA02366700OtherCAPTIAL BLUE CROSS
PA041264961Medicaid
PA7414134OtherGATEWAY
PA7414134OtherGATEWAY