Individual
PETER J FODOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
804 GRANDVIEW DR, STE 1, EPHRATA, PA 17522-1635
(717) 733-2251
Mailing address
804 GRANDVIEW DR, STE 1, EPHRATA, PA 17522-1635
(717) 733-2251
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
SC004412L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018417540003
—
PA
01
—
01320401
CAPITAL BLUE CROSS
PA
01
—
1520238
GATEWAY
PA
01
—
925809
HIGHMARK BLUE SHIELD
PA
Enumeration date
12/22/2005
Last updated
04/22/2008
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