Provider Demographics
NPI:1659561546
Name:PODIATRY ASSOCIATES OF EASTERN OHIO, LLC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF EASTERN OHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:765-962-0521
Mailing Address - Street 1:222 N 5TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935-1582
Mailing Address - Country:US
Mailing Address - Phone:740-633-4180
Mailing Address - Fax:740-633-4395
Practice Address - Street 1:222 N 5TH ST STE 204
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1582
Practice Address - Country:US
Practice Address - Phone:740-633-4180
Practice Address - Fax:740-633-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000953A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9327792Medicare PIN
OH9327791Medicare PIN