Provider Demographics
NPI:1922067958
Name:BEECH TREE PODIATRY, P.C.
Entity Type:Organization
Organization Name:BEECH TREE PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:DON
Authorized Official - Last Name:CHANTILES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-843-0896
Mailing Address - Street 1:1546 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-1255
Mailing Address - Country:US
Mailing Address - Phone:717-843-0896
Mailing Address - Fax:717-854-6519
Practice Address - Street 1:1546 E MARKET ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-1255
Practice Address - Country:US
Practice Address - Phone:717-843-0896
Practice Address - Fax:717-854-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017405730001Medicaid
PA0017405730001Medicaid
PA024751Medicare PIN