Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO619 | FL |
N | 222Z00000X | Podiatrist | PO619 | FL |
Y | 213E00000X | Podiatrist | SC001413L | PA |
Y | 222Z00000X | Podiatrist | SC001413L | PA |
NPI | 1043217698 |
---|---|
Provider Name | David Peter Bartos |
First Address | Wyomissing, PA 19610-1898 |
Second Address | Wyomissing, PA 19610-1898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0020417000 | KEYSTONE EAST (01) | PA |
0059639 | KETSTONE AND SENIOR BLUE (01) | PA |
01175401 | CAPITAL BLUE CROSS (01) | PA |
486556 | BLUE SHIELD (01) | PA |
T27714 | (02) | PA |