Provider Demographics
NPI:1093913691
Name:FAMILY FOOT CARE GROUP INC
Entity Type:Organization
Organization Name:FAMILY FOOT CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-593-1700
Mailing Address - Street 1:56 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4627
Mailing Address - Country:US
Mailing Address - Phone:781-593-1700
Mailing Address - Fax:617-776-3850
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:781-593-1700
Practice Address - Fax:617-776-3850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9760482Medicaid
MAY77123OtherBLUE SHIELD OF MA
MA600634OtherTUFTS HEALTH PLAN
MAY77123OtherBLUE SHIELD OF MA
MA9760482Medicaid
MA600634OtherTUFTS HEALTH PLAN
MADC5983Medicare PIN