Provider Demographics
NPI:1487644936
Name:DIVAIO, CAROL A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:A
Last Name:DIVAIO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3487
Mailing Address - Fax:617-724-3384
Practice Address - Street 1:55 FRUIT ST YAW 3056
Practice Address - Street 2:PODIATRY GROUP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3487
Practice Address - Fax:617-726-2739
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1888213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70893OtherBCBS MA
MA0362735Medicaid
MA718636OtherTUFTS HEALTH PLAN
MAY70893Medicare ID - Type Unspecified
MAY70893OtherBCBS MA