Provider Demographics
NPI:1710092390
Name:BARRETTA, CLIFTON A (DPM)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:A
Last Name:BARRETTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MEAD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3530
Mailing Address - Country:US
Mailing Address - Phone:814-337-3668
Mailing Address - Fax:814-337-3368
Practice Address - Street 1:105 MEAD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3530
Practice Address - Country:US
Practice Address - Phone:814-337-3668
Practice Address - Fax:814-337-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2011-04-27
Deactivation Date:2007-01-30
Deactivation Code:
Reactivation Date:2007-03-08
Provider Licenses
StateLicense IDTaxonomies
PASC004174R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001623020Medicaid
PA339840OtherHIGHMARK
PA001623020Medicaid
U63299Medicare UPIN