Provider Demographics
NPI:1063513588
Name:WATERS, DANA HARRIS (DPM)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:HARRIS
Last Name:WATERS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:DENISE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:648 CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3805
Mailing Address - Country:US
Mailing Address - Phone:484-521-0233
Mailing Address - Fax:484-521-0235
Practice Address - Street 1:648 CHILDS AVE
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3805
Practice Address - Country:US
Practice Address - Phone:484-521-0233
Practice Address - Fax:484-521-0235
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005782213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV12090Medicare UPIN
NJ110054Medicare ID - Type Unspecified