Provider Demographics
NPI:1316942998
Name:FAYETTE PODIATRY ASSOCIATES INC
Entity type:Organization
Organization Name:FAYETTE PODIATRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-785-8060
Mailing Address - Street 1:631A NATIONAL PIKE E
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15417-9603
Mailing Address - Country:US
Mailing Address - Phone:724-785-8060
Mailing Address - Fax:724-785-6217
Practice Address - Street 1:631A NATIONAL PIKE E
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417
Practice Address - Country:US
Practice Address - Phone:724-785-8060
Practice Address - Fax:724-785-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000938704Medicaid
PA0205050002Medicare NSC
PA444431Medicare PIN