Provider Demographics
NPI:1740373364
Name:HANOVER FOOT AND ANKLE ASSOCIATES, PC
Entity type:Organization
Organization Name:HANOVER FOOT AND ANKLE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:I
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-632-5264
Mailing Address - Street 1:250 FAME AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-5264
Mailing Address - Fax:717-632-1165
Practice Address - Street 1:250 FAME AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-5264
Practice Address - Fax:717-632-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003296L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0183410001Medicare NSC
PA781462Medicare PIN
PAU02177Medicare UPIN