Basic Information
| Provider Information | |||||||||
| NPI: | 1902352875 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARRISBURG FOOT AND ANKLE CENTER ,INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4033 LINGLESTOWN RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171121153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176510000 | ||||||||
| FaxNumber: | 7176510001 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 BRETZ COURT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWPORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170747250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176510000 | ||||||||
| FaxNumber: | 7176510001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2016 | ||||||||
| LastUpdateDate: | 08/30/2016 | ||||||||
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| AuthorizedOfficialLastName: | GROSSMAN | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | BRIAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7176510000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | SC003731L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.