Provider Demographics
NPI:1811275530
Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Entity type:Organization
Organization Name:KEYSTONE ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRAGONETTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-376-5646
Mailing Address - Street 1:2758 CENTURY BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3358
Mailing Address - Country:US
Mailing Address - Phone:610-376-5646
Mailing Address - Fax:610-376-8546
Practice Address - Street 1:2758 CENTURY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3358
Practice Address - Country:US
Practice Address - Phone:610-376-5646
Practice Address - Fax:610-376-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6396440007Medicare NSC