Provider Demographics
NPI:1184860835
Name:CANCELLIERE, PASQUALE (DPM)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:
Last Name:CANCELLIERE
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 1:645 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3172
Mailing Address - Country:US
Mailing Address - Phone:812-634-2778
Mailing Address - Fax:812-634-2909
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1448
Practice Address - Country:US
Practice Address - Phone:617-629-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA02371213ES0103X, 213E00000X
NH0363213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery