Provider Demographics
NPI:1811978844
Name:NAUGLE, KEVIN TODD (DPM)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:TODD
Last Name:NAUGLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-2769
Mailing Address - Country:US
Mailing Address - Phone:610-796-9522
Mailing Address - Fax:610-796-0105
Practice Address - Street 1:654 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2769
Practice Address - Country:US
Practice Address - Phone:610-796-9522
Practice Address - Fax:610-796-0105
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-003451-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU02168Medicare UPIN
PA608750Medicare ID - Type Unspecified