Provider Demographics
NPI:1407857451
Name:NV PODIATRY
Entity type:Organization
Organization Name:NV PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VILSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-621-5700
Mailing Address - Street 1:532 S AIKEN AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1521
Mailing Address - Country:US
Mailing Address - Phone:412-621-5700
Mailing Address - Fax:412-621-2890
Practice Address - Street 1:532 S AIKEN AVE
Practice Address - Street 2:STE 108
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1521
Practice Address - Country:US
Practice Address - Phone:412-621-5700
Practice Address - Fax:412-621-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001542L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA65298OtherMEDPLUS
PA251279OtherHEALTH AMERICA
PA1036711OtherGATEWAY
PACC6746OtherRAILROAD MEDICARE
PA000720224OtherAPWU
PA202304OtherUPMC
PA887857OtherBS
PA0016108820009Medicaid
PACC6746OtherRAILROAD MEDICARE