Provider Demographics
NPI:1134175193
Name:LIFECARE PODIATRY, P.C.
Entity type:Organization
Organization Name:LIFECARE PODIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-293-9383
Mailing Address - Street 1:237 N ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3537
Mailing Address - Country:US
Mailing Address - Phone:610-293-9383
Mailing Address - Fax:610-293-0409
Practice Address - Street 1:237 N ABERDEEN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3537
Practice Address - Country:US
Practice Address - Phone:610-293-9383
Practice Address - Fax:610-293-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015921020004Medicaid
0000426244OtherFEDERAL BLUE SHIELD
CF2898OtherRAILROAD MEDICARE
426244OtherBLUE CROSS BLUE SHIELD
0099575000OtherKEYSTONE HEALTH PLAN EAST
DE1000021434Medicaid
18844OtherHEALTH PARTNERS
000426244OtherHIGHMARK BLUE SHIELD
LI426244OtherUS HEALTHCARE
1011348OtherKEYSTONE MERCY
PA0015921020004Medicaid
0000426244OtherFEDERAL BLUE SHIELD
426244OtherBLUE CROSS BLUE SHIELD