Provider Demographics
NPI:1477984185
Name:LEGACY FOOT AND ANKLE SPECIALISTS
Entity Type:Organization
Organization Name:LEGACY FOOT AND ANKLE SPECIALISTS
Other - Org Name:CRIMSON FOOT AND ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM, MPH
Authorized Official - Phone:617-354-3131
Mailing Address - Street 1:123 MAYNARD FARM RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1012
Mailing Address - Country:US
Mailing Address - Phone:617-923-3998
Mailing Address - Fax:617-321-4075
Practice Address - Street 1:725 CONCORD AVE
Practice Address - Street 2:SUITE 3600
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1040
Practice Address - Country:US
Practice Address - Phone:617-354-3131
Practice Address - Fax:617-354-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2327213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
MA2328213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic MedicineGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty