| Organization Name: | LOCK HAVEN PODIATRY, L.L.C. |
| NPI Number: | 1407921380 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MITCHELL CHARLES ROSSMAN (OWNER) |
| Mailing Address: | 610 High St Specialists Clinic Lock Haven |
| State: | PA US |
| Postal Code: | 177453018 |
| Phone Number: | 5707481270 |
| Fax Number: | 5707481271 |
| NPI Enumeration Date: | 11/23/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | SC005592 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |