Provider Demographics
NPI:1497731657
Name:SCITUATE PODIATRY GROUP INC
Entity Type:Organization
Organization Name:SCITUATE PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:COUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-545-9285
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-0352
Mailing Address - Country:US
Mailing Address - Phone:781-545-9285
Mailing Address - Fax:781-545-9553
Practice Address - Street 1:2100 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5615
Practice Address - Country:US
Practice Address - Phone:617-296-0742
Practice Address - Fax:617-296-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001515213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781331Medicaid
MA606371OtherTUFTS GROUP #
MACH1562OtherRAILROAD MEDICARE #
MA3073090OtherNEIGHBORHOOD HEALTH PLAN
MAY78009Medicare PIN
MA9781331Medicaid