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Organization
SOUTHAMPTON PODIATRY ASSOCIATES
Active
Organization
SOUTHAMPTON PODIATRY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEMENT MICHAEL D'ANGELO D.P.M. (PARTNER/OWNER)
(215) 357-3668
Entity
Organization
Contact information
Practice address
981 ROZEL AVE, SOUTHAMPTON, PA 18966-4127
(215) 357-3668
Mailing address
981 ROZEL AVE, SOUTHAMPTON, PA 18966-4127
(215) 357-3668
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009770320002
—
PA
01
—
0023131000
IDEPEN. BC/KEYSTONE,PC
PA
01
—
125780
BLUE SHIELD
PA
Enumeration date
06/18/2006
Last updated
12/17/2012
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