Provider Demographics
NPI:1992079503
Name:CHRISTOPHER J. NAGLE, D.P.M., P.C.
Entity type:Organization
Organization Name:CHRISTOPHER J. NAGLE, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:724-981-6541
Mailing Address - Street 1:1951 SHENANGO VALLEY FWY
Mailing Address - Street 2:SUITE 3 NORTH
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2522
Mailing Address - Country:US
Mailing Address - Phone:724-981-6541
Mailing Address - Fax:724-982-0533
Practice Address - Street 1:1951 SHENANGO VALLEY FWY
Practice Address - Street 2:SUITE 3 NORTH
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2522
Practice Address - Country:US
Practice Address - Phone:724-981-6541
Practice Address - Fax:724-982-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004060R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
058200OtherHIGHMARK BLUE SHIELD
PA1496367Medicaid
U52364Medicare UPIN
PA236813Medicare PIN