Provider Demographics
NPI:1760559801
Name:SEDICUM, AUSTIN LANE III (DPM)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:LANE
Last Name:SEDICUM
Suffix:III
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 1:1040 S WEST END BLVD
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-529-6511
Mailing Address - Fax:215-529-6512
Practice Address - Street 1:1040 S WEST END BLVD
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-529-6511
Practice Address - Fax:215-529-6512
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005511213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2941264OtherAETNA HMO PIN
1418639OtherBS GROUP
063479Q2KOtherMEDICARE INDIVIDUAL
2103588000OtherKEYSTONE INDIVIDUAL GROUP
7802379OtherAETNA PPO PIN
50010317OtherCAPITAL GROUP
063480OtherMEDICARE PIN
50016192OtherCAPITAL INDIVIDUAL
2105345000OtherKEYSTONE GROUP
1417165OtherBS INDIVIDUAL
1417165OtherBS INDIVIDUAL
7802379OtherAETNA PPO PIN
U92384Medicare UPIN