Provider Demographics
NPI:1912934738
Name:ELLENBERGER, KARYN DIAN (DPM)
Entity Type:Individual
Prefix:MISS
First Name:KARYN
Middle Name:DIAN
Last Name:ELLENBERGER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 BIG BEAVER BLVD.
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1803
Mailing Address - Country:US
Mailing Address - Phone:724-843-7010
Mailing Address - Fax:
Practice Address - Street 1:6832 BIG BEAVER BLVD.
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1803
Practice Address - Country:US
Practice Address - Phone:724-843-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005701213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery