Provider Demographics
NPI:1700843158
Name:EDGEWOOD PODIATRY MEDICAL CENTER PC
Entity Type:Organization
Organization Name:EDGEWOOD PODIATRY MEDICAL CENTER PC
Other - Org Name:ASSOCIATED FOOT & ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTENZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-755-3911
Mailing Address - Street 1:3230 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3030
Mailing Address - Country:US
Mailing Address - Phone:717-755-0722
Mailing Address - Fax:717-757-7255
Practice Address - Street 1:3230 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-3030
Practice Address - Country:US
Practice Address - Phone:717-755-0722
Practice Address - Fax:717-757-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002766L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1548228059Medicare PIN
PA4232020001Medicare NSC
PA1003874512Medicare PIN
PA622509Medicare PIN
622509Medicare ID - Type Unspecified