Provider Demographics
NPI:1013226463
Name:SHORELINE FOOT & ANKLE CENTER, PC
Entity Type:Organization
Organization Name:SHORELINE FOOT & ANKLE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COURTRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:860-437-3737
Mailing Address - Street 1:85 POHEGANUT DR
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3252
Mailing Address - Country:US
Mailing Address - Phone:860-437-3737
Mailing Address - Fax:860-437-0530
Practice Address - Street 1:5 PEQUOT PARK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:860-437-3737
Practice Address - Fax:860-437-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000607332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies