Provider Demographics
NPI:1770527541
Name:VERMA PONTARELLI & SUTERA ASSOC
Entity type:Organization
Organization Name:VERMA PONTARELLI & SUTERA ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE & BUS MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-566-5236
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3305
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-566-5236
Mailing Address - Fax:610-891-7135
Practice Address - Street 1:1098 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 3305
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-566-5236
Practice Address - Fax:610-891-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAVE647967Medicare ID - Type Unspecified