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Organization
RAYSTOWN PODIATRY LLC
Active
Organization
RAYSTOWN PODIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMMY E. CARLSON-LITTLE D.P.M. (OWNER)
(814) 643-1720
Entity
Organization
Contact information
Practice address
1201 MOORE ST, HUNTINGDON, PA 16652-1826
(814) 643-1720
(814) 643-4953
Mailing address
1201 MOORE ST, HUNTINGDON, PA 16652-1826
(814) 643-1720
(814) 643-4953
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007621509
AETNA
—
01
—
01489224
BLUE SHIELD
PA
05
—
1019577160001
—
PA
01
—
1956490
BLUE SHIELD
PA
01
—
323538
UPMC HEALTH PLAN
PA
01
—
P00278620
TRAVELERS MEDICARE
—
Enumeration date
01/17/2007
Last updated
03/15/2010
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