Provider Demographics
NPI:1598070658
Name:NORTH PENN PODIATRY LLC
Entity Type:Organization
Organization Name:NORTH PENN PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKALARI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-337-3322
Mailing Address - Street 1:914 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2328
Mailing Address - Country:US
Mailing Address - Phone:215-855-8122
Mailing Address - Fax:215-855-7908
Practice Address - Street 1:914 N BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2328
Practice Address - Country:US
Practice Address - Phone:215-855-8122
Practice Address - Fax:215-855-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001515L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA184905Medicare UPIN