Provider Demographics
NPI:1710912845
Name:STANLEY D. BOSTA DPM PC
Entity Type:Organization
Organization Name:STANLEY D. BOSTA DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-461-1108
Mailing Address - Street 1:495 WATERFRONT DR E
Mailing Address - Street 2:SUITE230
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1140
Mailing Address - Country:US
Mailing Address - Phone:412-461-1108
Mailing Address - Fax:412-461-5490
Practice Address - Street 1:495 WATERFRONT DR E
Practice Address - Street 2:SUITE230
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1140
Practice Address - Country:US
Practice Address - Phone:412-461-1108
Practice Address - Fax:412-461-5490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA480023599OtherRAILROAD MEDICARE
PA1083686034OtherINDIVIDUAL NPI
PA0005069140003Medicaid
PA063793XXYOtherMEDICARE GROUP PROV#
PA1382437OtherHIGHMARK BS ID NUMBER
PA1382437OtherHIGHMARK BS ID NUMBER
PA63793Medicare ID - Type Unspecified
PA480023599OtherRAILROAD MEDICARE