Provider Demographics
NPI:1629052535
Name:SCITUATE PODIATRY GROUP INC
Entity Type:Organization
Organization Name:SCITUATE PODIATRY GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:
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 1:10 NEW DRIFTWAY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066
Practice Address - Country:US
Practice Address - Phone:781-545-9285
Practice Address - Fax:781-545-9553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MACG5531OtherRAILROAD MEDICARE
MA9781331Medicaid
MA0009377OtherNEIGHBORHOOD HEALTH PLAN
MAY77175OtherBLUECROSS BLUESHEILD
MA606371OtherTUFTS
MA606371OtherTUFTS