Provider Demographics
NPI:1699793018
Name:SIMON, RICK LAWRENCE (DPM)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:LAWRENCE
Last Name:SIMON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2520
Mailing Address - Country:US
Mailing Address - Phone:215-362-2220
Mailing Address - Fax:
Practice Address - Street 1:231 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2520
Practice Address - Country:US
Practice Address - Phone:215-362-2220
Practice Address - Fax:215-362-5307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002656L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2418874000OtherIBC
PA0009128510004Medicaid
PAP00341208OtherRAILROAD MEDICARE
PA2418874000OtherIBC
PAP00341208OtherRAILROAD MEDICARE
PA1303140001Medicare NSC