Provider Demographics
NPI:1801873690
Name:LANCASTER COUNTY PODIATRY LLP
Entity type:Organization
Organization Name:LANCASTER COUNTY PODIATRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-733-2251
Mailing Address - Street 1:804 GRANDVIEW DR
Mailing Address - Street 2:STE 1
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1635
Mailing Address - Country:US
Mailing Address - Phone:717-733-2251
Mailing Address - Fax:
Practice Address - Street 1:804 GRANDVIEW DR
Practice Address - Street 2:STE 1
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1635
Practice Address - Country:US
Practice Address - Phone:717-733-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1515009OtherGATEWAY
PA561286OtherAETNA
PA0018077160005Medicaid
PA02359500OtherCAPITAL BLUE CROSS
PA541613OtherHIGHMARK BLUE SHIELD
PA541613Medicare PIN