Provider Demographics
NPI:1710934260
Name:MARKANTONE, GREGORY S (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:MARKANTONE
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 1:3863 ROUTE 30
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5256
Mailing Address - Country:US
Mailing Address - Phone:724-539-7050
Mailing Address - Fax:724-539-7053
Practice Address - Street 1:3863 ROUTE 30
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-5256
Practice Address - Country:US
Practice Address - Phone:724-539-7050
Practice Address - Fax:724-539-7053
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003702R213E00000X, 213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001510410Medicaid
PA723963Medicare ID - Type Unspecified