| Organization Name: | BANGOR PODIATRY LLC |
| NPI Number: | 1972996189 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHERALYN PERKINS (OWNER) |
| Mailing Address: | 1636 Route 209 Bk Plaza, Unit 1 Brodheadsville |
| State: | PA US |
| Postal Code: | 183227799 |
| Phone Number: | 5709925779 |
| Fax Number: | 5709925806 |
| NPI Enumeration Date: | 03/12/2015 |
| NPI Last Update Date: | 03/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | SC004468L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |