Provider Demographics
NPI:1770668204
Name:CHRISTOPHER A PANEK DPM PC
Entity type:Organization
Organization Name:CHRISTOPHER A PANEK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:724-758-4900
Mailing Address - Street 1:601 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117
Mailing Address - Country:US
Mailing Address - Phone:724-758-4900
Mailing Address - Fax:724-758-8190
Practice Address - Street 1:601 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117
Practice Address - Country:US
Practice Address - Phone:724-758-4900
Practice Address - Fax:724-758-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004669R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADP6029OtherMEDICARE RAILROAD
PA434455OtherBLUE SHIELD
PADP6029OtherMEDICARE RAILROAD
PA081907Medicare PIN