Provider Demographics
NPI:1700824117
Name:PODIATRY ASSOCIATES OF EASTERN OH LLC
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF EASTERN OH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GAFFNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:740-633-4180
Mailing Address - Street 1:222 N 5TH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935
Mailing Address - Country:US
Mailing Address - Phone:740-633-4180
Mailing Address - Fax:740-633-4395
Practice Address - Street 1:222 N 5TH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935
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:2006-06-04
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003025G213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3025EOtherUPPER OH VALLEY HLTH PLAN
001708264OtherMOUNTAIN STATE BCBS
OH000000140720OtherANTHEM BLUE CROSS SHIELD
OH2019943Medicaid
4800256391OtherMEDICARE RAILROAD
9327791Medicare ID - Type Unspecified
3025EOtherUPPER OH VALLEY HLTH PLAN
9327791Medicare ID - Type UnspecifiedEAST OHIO REG HOSP 4TH ST
9327793Medicare ID - Type UnspecifiedST CLAIRSVILLE
U62147Medicare UPIN
9327791Medicare ID - Type UnspecifiedLONG TERM CARE
OH2019943Medicaid