Provider Demographics
NPI:1417510637
Name:FROM THE GROUND UP PODIATRY
Entity Type:Organization
Organization Name:FROM THE GROUND UP PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:603-502-4216
Mailing Address - Street 1:21 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-3212
Mailing Address - Country:US
Mailing Address - Phone:603-502-4216
Mailing Address - Fax:
Practice Address - Street 1:72 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2566
Practice Address - Country:US
Practice Address - Phone:603-502-4216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty