Provider Demographics
NPI:1073725370
Name:LAUREL PODIATRY ASSOCIATES LLC
Entity type:Organization
Organization Name:LAUREL PODIATRY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-832-7880
Mailing Address - Street 1:235 HUMPHREY ROAD
Mailing Address - Street 2:SUITE 4 TWO PINEVIEW PLACE
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-832-7880
Mailing Address - Fax:724-832-8172
Practice Address - Street 1:235 HUMPHREY ROAD
Practice Address - Street 2:SUITE 4 TWO PINEVIEW PLACE
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-832-7880
Practice Address - Fax:724-832-8172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1460887OtherBEST HEALTHCARE
PA256974OtherBLUE SHIELD
PA480018318OtherPRUDENTIAL AARP GROUP
PAE000OtherUPMC
PA1003950OtherGATEWAY
PA1739661Medicaid
PA14897718OtherUNITED MINE WORKERS
PA56409OtherMEDPLUS THREE RIVERS
PA=========OtherAETNA USHC
PA3997680001Medicare NSC
PA1739661Medicaid