Provider Demographics
NPI:1346505666
Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE GROUP, PC
Entity type:Organization
Organization Name:ORTHOPAEDIC SURGERY AND SPORTS MEDICINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MAINIERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-644-7755
Mailing Address - Street 1:254 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3087
Mailing Address - Country:US
Mailing Address - Phone:610-644-7755
Mailing Address - Fax:610-644-8290
Practice Address - Street 1:254 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3087
Practice Address - Country:US
Practice Address - Phone:610-644-7755
Practice Address - Fax:610-644-8290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017799Medicare PIN