Provider Demographics
NPI:1619985330
Name:PRO, ARMAND LOUIS (DPM)
Entity Type:Individual
Prefix:
First Name:ARMAND
Middle Name:LOUIS
Last Name:PRO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BALSAM RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3230
Mailing Address - Country:US
Mailing Address - Phone:856-963-1221
Mailing Address - Fax:856-963-1222
Practice Address - Street 1:211 S BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1207
Practice Address - Country:US
Practice Address - Phone:856-963-1221
Practice Address - Fax:856-963-1222
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00086300213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2383004Medicaid
048486Medicare ID - Type UnspecifiedMEDICARE
T75584Medicare UPIN