Provider Demographics
NPI:1831736024
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:MANAGING EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:BLANCHE
Authorized Official - Middle Name:LOIS
Authorized Official - Last Name:YARGO
Authorized Official - Suffix:
Authorized Official - Credentials:
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:16117-1945
Mailing Address - Country:US
Mailing Address - Phone:724-758-4900
Mailing Address - Fax:724-758-8190
Practice Address - Street 1:9000 PERRY HWY STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-5367
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:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA434455OtherBLUE SHIELD