Provider Demographics
NPI:1689851305
Name:ERIC EGELMAN
Entity Type:Organization
Organization Name:ERIC EGELMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MILES
Authorized Official - Last Name:EGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-527-0015
Mailing Address - Street 1:121 WEST 8TH ST.
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:PA
Mailing Address - Zip Code:17082
Mailing Address - Country:US
Mailing Address - Phone:717-527-0015
Mailing Address - Fax:717-527-4183
Practice Address - Street 1:121 WEST 8TH ST.
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:PA
Practice Address - Zip Code:17082
Practice Address - Country:US
Practice Address - Phone:717-527-0015
Practice Address - Fax:717-527-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC 003223 L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02320200OtherKEYSTONE
PA001175146 0004Medicaid
PA120833269OtherGEISINGER HEALTH PLAN
PA256127OtherHIGHMARK BLUE SHIELD
PA3514070OtherCZGNA
PA480027522OtherRAILROAD MEDICARE
PA02320200OtherCAPITOL BLUE CROSS
PA88127OtherHEALTH AMERICA
PA02320200OtherKEYSTONE
PA88127OtherHEALTH AMERICA