person
John J Distazio, DPM
Foot & Ankle Surgery Podiatrist in Homestead, Pennsylvania
NPI 1366414088

John J Distazio is a Foot & Ankle Surgery Podiatrist based in Homestead, PA and is specialized in Foot & Ankle Surgery. John J Distazio practices in Homestead, PA and has the professional credentials of DPM. The NPI Number for John J Distazio is 1366414088 and holds a License No. SC002842L (Pennsylvania).

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

Location: 495 Waterfront Dr E, Homestead, PA, 15120-1140
person
Provider Profile Details
NPI Number
1366414088
Provider Name
John J Distazio
Credential
DPM
Provider Entity Type
Individual
Gender
Male
Address
495 Waterfront Dr E, Homestead, PA, 15120-1140
Phone Number
412-461-1108
Fax Number
412-461-5490
Provider Enumeration Date
02/06/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0004134486 01 PA AETNA PIN
1156610001 01 PA DMERC PROV NUMBER
455619 01 PA HIGHMARK GRP PROV NUMBER
0010941370001 05 PA
1009921 01 PA GATEWAY HMO NUMBER
1205011277 01 PA DMERC NPI NUMBER
1316123052 01 PA RR MEDICARE GROUP NPI
175132 01 PA HIGHMARK INDIVIDUAL PROV#
175132XXX 01 PA MC GROUP PROV NUMBER
1316123052 01 PA MC GROUP NPI NUMBER
1710911912 01 PA HIGHMARK GROUP NPI NUMBER
institution
Provider Business Practice Location Address Details
Address
495 Waterfront Dr E
City
State
Zip
15120-1140
Phone Number
412-461-1108
Fax Number
412-461-5490
person
Provider Business Mailing Address Details
Address
495 Waterfront Dr E
City
State
Zip
15120-1140
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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