Provider Demographics
NPI:1790785947
Name:LAFATA, PAUL C (DPM)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:LAFATA
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 1:25 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1424
Mailing Address - Country:US
Mailing Address - Phone:610-678-4581
Mailing Address - Fax:610-678-8677
Practice Address - Street 1:25 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1424
Practice Address - Country:US
Practice Address - Phone:610-678-4581
Practice Address - Fax:610-678-8677
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004661-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1462377OtherHIGHMARK BLUE SHIELD
PA50015444OtherCAPITAL BLUE CROSS
PAP00203039OtherPALMETTO GBA
PA1462377OtherHIGHMARK BLUE SHIELD
PA50015444OtherCAPITAL BLUE CROSS