Provider Demographics
NPI:1891783312
Name:AFFILIATED PODIARTRISTS PA
Entity Type:Organization
Organization Name:AFFILIATED PODIARTRISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-825-2443
Mailing Address - Street 1:7402 YORK RD
Mailing Address - Street 2:#104
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7532
Mailing Address - Country:US
Mailing Address - Phone:410-825-2443
Mailing Address - Fax:410-321-7040
Practice Address - Street 1:7402 YORK RD
Practice Address - Street 2:#104
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7532
Practice Address - Country:US
Practice Address - Phone:410-825-2443
Practice Address - Fax:410-321-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3514OtherBS DC
MDCEO167OtherMEDICARE RAILROAD
PA981408600Medicaid
H998OtherBS
MDCEO167OtherMEDICARE RAILROAD
3514OtherBS DC