Provider Demographics
NPI:1871524645
Name:MCCANTS, SEAN A (DPM)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:A
Last Name:MCCANTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SNYDER AVE # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-5512
Mailing Address - Country:US
Mailing Address - Phone:215-465-5342
Mailing Address - Fax:800-537-1174
Practice Address - Street 1:5656 CHEW AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1742
Practice Address - Country:US
Practice Address - Phone:215-991-9211
Practice Address - Fax:215-991-9321
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASCOO5626213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2225531000OtherAMERIHEALTH
PA30020475OtherKEYSTONE MERCY
PA01968145Medicaid
PA072163TSPMedicare PIN
PAU96359Medicare UPIN
PA5665440002Medicare NSC