Provider Demographics
NPI:1972579217
Name:FOEDISCH, GEORGE T
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:T
Last Name:FOEDISCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:665 HARLEYSVILLE PIKE
Mailing Address - City:FRANCONIA
Mailing Address - State:PA
Mailing Address - Zip Code:18924-0067
Mailing Address - Country:US
Mailing Address - Phone:215-721-2300
Mailing Address - Fax:215-721-9655
Practice Address - Street 1:665 HARLEYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:FRANCONIA
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-721-2300
Practice Address - Fax:215-721-9655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002921L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0048403000OtherBLUE CROSS/BLUE SHIELD
PA0048403000OtherKEYSTONE HEALTH PLAN EAST
PAT72372Medicare UPIN
PA0048403000OtherBLUE CROSS/BLUE SHIELD