Provider Demographics
NPI:1649381666
Name:NANTICOKE PODIATRY PA
Entity Type:Organization
Organization Name:NANTICOKE PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-628-7880
Mailing Address - Street 1:8857 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3654
Mailing Address - Country:US
Mailing Address - Phone:302-628-7880
Mailing Address - Fax:302-628-3791
Practice Address - Street 1:8857 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3654
Practice Address - Country:US
Practice Address - Phone:302-628-7880
Practice Address - Fax:302-628-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000077213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000095817Medicaid
DE0797430001Medicare NSC
DE0000095817Medicaid
DET26898Medicare UPIN