Provider Demographics
NPI:1972960128
Name:MARTIN PODIATRY PC
Entity Type:Organization
Organization Name:MARTIN PODIATRY PC
Other - Org Name:MARTIN FOOT AND ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNKERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-757-3537
Mailing Address - Street 1:2300 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9627
Mailing Address - Country:US
Mailing Address - Phone:717-757-3537
Mailing Address - Fax:717-718-8674
Practice Address - Street 1:1038 LITITZ PIKE
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9328
Practice Address - Country:US
Practice Address - Phone:717-757-3537
Practice Address - Fax:717-718-8674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA428935Medicare PIN