Provider Demographics
NPI:1609824168
Name:GATEWAY FOOT & ANKLE, PC
Entity Type:Organization
Organization Name:GATEWAY FOOT & ANKLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DERRICO
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:QUATTRONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-405-8065
Mailing Address - Street 1:1907 LEBANON CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-2456
Mailing Address - Country:US
Mailing Address - Phone:412-653-0566
Mailing Address - Fax:412-653-0466
Practice Address - Street 1:1633 ROUTE 51 STE 201
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3652
Practice Address - Country:US
Practice Address - Phone:412-405-8065
Practice Address - Fax:412-405-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003461R213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1260327Medicaid
PA1260327Medicaid
PAU02170Medicare UPIN
PA5707230001Medicare NSC