Provider Demographics
NPI:1427277508
Name:DRS CHARLES P AND KAREN F SANICOLA PA
Entity type:Organization
Organization Name:DRS CHARLES P AND KAREN F SANICOLA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARELS
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:SANICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-790-2270
Mailing Address - Street 1:372 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6138
Mailing Address - Country:US
Mailing Address - Phone:301-790-2270
Mailing Address - Fax:301-790-2327
Practice Address - Street 1:372 MILL ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6138
Practice Address - Country:US
Practice Address - Phone:301-790-2270
Practice Address - Fax:301-790-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1427277508OtherGROUP NPI
MDDN5937OtherRAILROAD MEDICARE GROUP PTAN
MDDN5937OtherRAILROAD MEDICARE GROUP PTAN
MD0767390001Medicare NSC