Provider Demographics
NPI:1609059187
Name:PALMER PODIATRY
Entity Type:Organization
Organization Name:PALMER PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELONIE
Authorized Official - Middle Name:ROMINA
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-792-1961
Mailing Address - Street 1:10 BASSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-1927
Mailing Address - Country:US
Mailing Address - Phone:302-475-6879
Mailing Address - Fax:302-792-1961
Practice Address - Street 1:1004 SOCIETY DR
Practice Address - Street 2:
Practice Address - City:CLAYMONT
Practice Address - State:DE
Practice Address - Zip Code:19703-1782
Practice Address - Country:US
Practice Address - Phone:302-792-1961
Practice Address - Fax:302-792-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000131332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1113980001Medicare NSC