Provider Demographics
NPI:1851380596
Name:QUARRYVILLE FAMILY FOOT CARE, P.C.
Entity Type:Organization
Organization Name:QUARRYVILLE FAMILY FOOT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-786-8896
Mailing Address - Street 1:104 FITE WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9395
Mailing Address - Country:US
Mailing Address - Phone:717-786-8896
Mailing Address - Fax:717-786-8367
Practice Address - Street 1:104 FITE WAY
Practice Address - Street 2:SUITE B
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9395
Practice Address - Country:US
Practice Address - Phone:717-786-8896
Practice Address - Fax:717-786-8367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-15
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004722L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU84101Medicare UPIN
PA085101Medicare ID - Type Unspecified
PA5536940001Medicare NSC