Basic Information
| Provider Information | |||||||||
| NPI: | 1508386665 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSELMO | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 SENTINEL RDG # 8109 | ||||||||
| Address2: | |||||||||
| City: | EAGLEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194036301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158668622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 140 NUTT RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIXVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194603906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109831000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 06/29/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | SC006858 | PA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.