Provider Demographics
NPI:1861544645
Name:SAMUEL QUARTEY DPM PC
Entity type:Organization
Organization Name:SAMUEL QUARTEY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:FERGUSON
Authorized Official - Last Name:QUARTEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-471-1407
Mailing Address - Street 1:5023 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139
Mailing Address - Country:US
Mailing Address - Phone:215-471-1407
Mailing Address - Fax:215-471-6061
Practice Address - Street 1:5023 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139
Practice Address - Country:US
Practice Address - Phone:215-471-1407
Practice Address - Fax:215-471-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC00208IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000540237Medicaid
095915OtherPERSONAL CHOICE BCBS
0060592000OtherKEYSTONE HEALTH PLAN EAST
PA0000540237Medicaid
T28496Medicare UPIN