Provider Demographics
NPI:1598778029
Name:LATZANICH, CAROL M (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:M
Last Name:LATZANICH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:175 E BROWN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-3098
Mailing Address - Country:US
Mailing Address - Phone:570-424-1031
Mailing Address - Fax:570-424-5086
Practice Address - Street 1:175 E BROWN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3098
Practice Address - Country:US
Practice Address - Phone:570-424-1031
Practice Address - Fax:570-424-5086
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC003741-L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA056913Medicare ID - Type Unspecified
PAU34106Medicare UPIN