Provider Demographics
NPI:1831182104
Name:LAFATA, PAUL N (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:LAFATA
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 1:25 STEVENS AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-1424
Mailing Address - Country:US
Mailing Address - Phone:610-678-4581
Mailing Address - Fax:610-678-4599
Practice Address - Street 1:25 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1424
Practice Address - Country:US
Practice Address - Phone:610-678-4581
Practice Address - Fax:610-678-4599
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001317-L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011753-01OtherCAPITAL BLUE CROSS
PAP00203034OtherPALMETTO GBA
PALA48605OtherHIGHMARK BLUE SHIELD
PA048605T35Medicare ID - Type Unspecified
PAP00203034OtherPALMETTO GBA