Provider Demographics
NPI:1093307811
Name:MAIN STREET PODIATRY, PC
Entity Type:Organization
Organization Name:MAIN STREET PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-533-3500
Mailing Address - Street 1:730 MAIN ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1612
Mailing Address - Country:US
Mailing Address - Phone:508-533-3500
Mailing Address - Fax:
Practice Address - Street 1:730 MAIN ST STE 1D
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1612
Practice Address - Country:US
Practice Address - Phone:508-533-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty