Provider Demographics
NPI:1932427762
Name:MAXKA, JIM (DPM)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:MAXKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1055 BALTIMORE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-4400
Mailing Address - Country:US
Mailing Address - Phone:717-524-1034
Mailing Address - Fax:833-524-1034
Practice Address - Street 1:1055 BALTIMORE ST STE 1
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4400
Practice Address - Country:US
Practice Address - Phone:717-524-1034
Practice Address - Fax:833-524-1034
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASC006213213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA475299ZXTEMedicare PIN