Provider Demographics
NPI:1265731863
Name:MAKER, JARED MATTHEW (DPM)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:MATTHEW
Last Name:MAKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NORTHPOINTE CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:SEVEN FIELDS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-7867
Mailing Address - Country:US
Mailing Address - Phone:724-687-8790
Mailing Address - Fax:
Practice Address - Street 1:400 NORTHPOINTE CIR STE 102
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-7867
Practice Address - Country:US
Practice Address - Phone:724-687-8790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003725213ES0103X
IL016005848213ES0103X
PASC006216213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102981304-0004Medicaid
FLHH882YOtherMEDICARE PTAN