Provider Demographics
NPI:1083780258
Name:FAMILY FOOT CARE CENTER PC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONTAINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-874-1300
Mailing Address - Street 1:32 STATE ROAD EAST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473
Mailing Address - Country:US
Mailing Address - Phone:978-874-1300
Mailing Address - Fax:978-874-6244
Practice Address - Street 1:32 STATE ROAD EAST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473
Practice Address - Country:US
Practice Address - Phone:978-874-1300
Practice Address - Fax:978-874-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA610926OtherTUFTS HEALTH PLAN
MAAA21094OtherHARVARD PILGRIM HEALTH
MA9741381Medicaid
MAY77347OtherBLUE SHEILD OF MA
MA2196OtherFALLON
MAU63205Medicare UPIN
MA6079360001Medicare NSC
MA610926OtherTUFTS HEALTH PLAN
MA9741381Medicaid