Provider Demographics
NPI:1821214818
Name:URDA, KERRY MICHAEL (DPM DOCTOR OF PODIAT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:MICHAEL
Last Name:URDA
Suffix:
Gender:M
Credentials:DPM DOCTOR OF PODIAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 WEST END DRIVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2234
Mailing Address - Country:US
Mailing Address - Phone:215-477-7185
Mailing Address - Fax:215-477-2185
Practice Address - Street 1:1533 WEST END DRIVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2234
Practice Address - Country:US
Practice Address - Phone:215-477-7185
Practice Address - Fax:215-477-2185
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003661L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAUR417417Medicare ID - Type Unspecified
U37522Medicare UPIN