Provider Demographics
NPI:1740275635
Name:PASCARELLA HOOVER FINKELSTEIN & WAGNER DPM PA
Entity type:Organization
Organization Name:PASCARELLA HOOVER FINKELSTEIN & WAGNER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-339-7759
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-339-7759
Mailing Address - Fax:407-830-0024
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-339-7759
Practice Address - Fax:407-830-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1125200001OtherDMERC NSC
FL1D029736400Medicaid
FLCM9370OtherMRR GROUP NUMBER
FL1125200001OtherDMERC NSC
FL1D029736400Medicaid