Provider Demographics
NPI:1003091612
Name:ORTHOPEDIC SPECIALISTS OF POTTSTOWN INC
Entity type:Organization
Organization Name:ORTHOPEDIC SPECIALISTS OF POTTSTOWN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-906-0101
Mailing Address - Street 1:1200 E HIGH ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-4954
Mailing Address - Country:US
Mailing Address - Phone:610-906-0101
Mailing Address - Fax:610-970-2334
Practice Address - Street 1:1200 E HIGH ST
Practice Address - Street 2:SUITE 307
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-4954
Practice Address - Country:US
Practice Address - Phone:610-906-0101
Practice Address - Fax:610-970-2334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009731E207X00000X
PAMD011681E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA045198USYMedicaid
PA045198USYMedicaid