Provider Demographics
NPI:1639484991
Name:AVIS, ASTRID (DPM)
Entity Type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:
Last Name:AVIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ASTRID
Other - Middle Name:
Other - Last Name:PAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:45 E ORANGE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-5123
Mailing Address - Country:US
Mailing Address - Phone:717-672-0400
Mailing Address - Fax:717-824-3466
Practice Address - Street 1:45 E ORANGE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-5123
Practice Address - Country:US
Practice Address - Phone:717-672-0400
Practice Address - Fax:717-824-3466
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006166213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10255237400001Medicaid
PA202554OtherMEDICARE GROUP NUMBER
PA202554OtherMEDICARE GROUP NUMBER
PA202553YDP4Medicare PIN