Provider Demographics
NPI:1891872313
Name:BUXMONT PODIATRY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:BUXMONT PODIATRY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-672-3222
Mailing Address - Street 1:399 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4516
Mailing Address - Country:US
Mailing Address - Phone:215-672-3222
Mailing Address - Fax:215-672-6634
Practice Address - Street 1:399 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4516
Practice Address - Country:US
Practice Address - Phone:215-672-3222
Practice Address - Fax:215-672-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001284L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA037389009OtherUNITED HEALTHCARE
PA00023128000OtherAMERHEALTH HMO
PA0002654OtherAETNA
PA123710OtherHIGHMARK BLUE SHIELD
PABU179OtherOXFORD
PA0023128000OtherKEYSTONE BLUE SHIELD
PA02018OtherHEALTH PARTNERS
PAP0071007OtherTRICARE
PA037389009OtherUNITED HEALTHCARE
PA109058Medicare PIN