institution
John J Distazio, D.p.m., P.c.
Foot & Ankle Surgery Podiatrist in Homestead, Pennsylvania
NPI 1316123052

John J Distazio, D.p.m., P.c. is a Foot & Ankle Surgery Podiatrist based in Homestead, PA and is specialized in Foot & Ankle Surgery. John J Distazio, D.p.m., P.c. practices in Homestead, PA. The NPI Number for John J Distazio, D.p.m., P.c. is 1316123052 and holds a License No. SC002842L (Pennsylvania).

The current practice location address for John J Distazio, D.p.m., P.c. is 495 E Waterfront Drive, Homestead, PA and can be reached out via phone at 412-461-1108 and via fax at 412-461-5490.

Location: 495 E Waterfront Drive, Homestead, PA, 15120-1151
institution
Provider Profile Details
NPI Number
1316123052
Provider Name
John J Distazio, D.p.m., P.c.
Credential
Provider Entity Type
Organization
Address
495 E Waterfront Drive, Homestead, PA, 15120-1151
Phone Number
412-461-1108
Fax Number
412-461-5490
Provider Enumeration Date
01/11/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1316123052 01 PA MC GROUP NPI NUMBER
1366414088 01 PA INDIVIDUAL NPI NUMBER
175132XXX 01 PA MC GROUP PROVIDER NUMBER
175132 01 PA MEDICARE LEGACY NUMBER
0010941370001 05 PA
institution
Provider Business Practice Location Address Details
Address
495 E Waterfront Drive
City
State
Zip
15120-1151
Phone Number
412-461-1108
Fax Number
412-461-5490
person
Provider Business Mailing Address Details
Address
495 E Waterfront Drive
City
State
Zip
15120-1151
Phone Number
412-461-1108
Fax Number
412-461-5490
person
Provider's Taxonomy Details 1
Type
Podiatric Medicine & Surgery Service Providers
Classification
Podiatrist
Speciality
Foot & Ankle Surgery
Taxonomy
License No.
SC002842L (Pennsylvania)
Definition
Definition to come...
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