Provider Demographics
NPI:1982667952
Name:MONTGOMERY PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:MONTGOMERY PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-938-7725
Mailing Address - Street 1:727 WELSH RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6357
Mailing Address - Country:US
Mailing Address - Phone:215-938-7725
Mailing Address - Fax:215-938-7990
Practice Address - Street 1:727 WELSH RD
Practice Address - Street 2:SUITE 203
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-938-7725
Practice Address - Fax:215-938-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA021675Medicare ID - Type Unspecified
PA2033120001Medicare NSC
PA021675Medicare PIN