Provider Demographics
NPI:1740462985
Name:JOSEPHINE DEPALMA DPM
Entity type:Organization
Organization Name:JOSEPHINE DEPALMA DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPALMA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-483-9610
Mailing Address - Street 1:226 W RITTENHOUSE SQ
Mailing Address - Street 2:APT 2408
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5768
Mailing Address - Country:US
Mailing Address - Phone:215-483-9610
Mailing Address - Fax:215-483-9679
Practice Address - Street 1:5735 RIDGE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1745
Practice Address - Country:US
Practice Address - Phone:215-483-9610
Practice Address - Fax:215-483-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002712L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010107900004Medicaid
PA0527760002Medicare NSC
PADE454937Medicare PIN
PAT30532Medicare UPIN