Provider Demographics
NPI:1598946832
Name:DANIEL C. DUFFY, DPM, INC
Entity Type:Organization
Organization Name:DANIEL C. DUFFY, DPM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-282-1221
Mailing Address - Street 1:1740 COOPER FOSTER PARK RD W
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4201
Mailing Address - Country:US
Mailing Address - Phone:440-282-1221
Mailing Address - Fax:440-960-0010
Practice Address - Street 1:445 GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2304
Practice Address - Country:US
Practice Address - Phone:440-282-1221
Practice Address - Fax:440-960-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-00-1892D213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0195006Medicaid
OH0449447Medicaid
OH0393659Medicaid
OH0460011Medicare PIN
OH0393659Medicaid
OH0490022Medicare PIN