Provider Demographics
NPI:1619542917
Name:ALLIED PODIATRIC AND VASCULAR INSTITUTE LLC
Entity Type:Organization
Organization Name:ALLIED PODIATRIC AND VASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-405-9090
Mailing Address - Street 1:831 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1215
Mailing Address - Country:US
Mailing Address - Phone:267-405-9090
Mailing Address - Fax:215-240-1677
Practice Address - Street 1:831 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1215
Practice Address - Country:US
Practice Address - Phone:267-405-9090
Practice Address - Fax:215-240-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty