Provider Demographics
NPI:1659994283
Name:SEWICKLEY FOOT AND ANKLE, PC
Entity Type:Organization
Organization Name:SEWICKLEY FOOT AND ANKLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-741-4470
Mailing Address - Street 1:1099 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-2056
Mailing Address - Country:US
Mailing Address - Phone:412-741-4470
Mailing Address - Fax:412-741-1332
Practice Address - Street 1:1099 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-2056
Practice Address - Country:US
Practice Address - Phone:412-741-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982126827OtherAUTHORIZED PROVIDER NPI
PASCOO6872OtherSTATE LICENSE