Organization
PORTAGE PODIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REGINA A GOUGHNOUR (OFFICE MANAGER)
(814) 736-5000
Entity
Organization
Contact information
Practice address
220 MAIN ST STE 100, PORTAGE, PA 15946-1119
(814) 736-5000
(814) 736-5000
Mailing address
220 MAIN ST STE 100, PORTAGE, PA 15946-1119
(814) 736-5000
(814) 736-5000
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004705L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043195
UMWA
PA
Enumeration date
02/01/2008
Last updated
02/01/2008
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