Provider Demographics
NPI:1528144110
Name:GRETZ WARD, RHONDA R (DPM)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:R
Last Name:GRETZ WARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:419 N CHESTNUT ST
Mailing Address - City:SUITE A
Mailing Address - State:PA
Mailing Address - Zip Code:15683
Mailing Address - Country:US
Mailing Address - Phone:724-887-2900
Mailing Address - Fax:724-887-5477
Practice Address - Street 1:419 N CHESTNUT ST
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683
Practice Address - Country:US
Practice Address - Phone:724-887-2900
Practice Address - Fax:724-887-5477
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004448R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017248000001Medicaid
GR020472Medicare ID - Type Unspecified
PA0017248000001Medicaid