Provider Demographics
NPI:1639462401
Name:ALICIA R GUIDONE, DPM LLC
Entity Type:Organization
Organization Name:ALICIA R GUIDONE, DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:RAMONA
Authorized Official - Last Name:GUIDONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-640-0385
Mailing Address - Street 1:101 HALF MILE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4101
Mailing Address - Country:US
Mailing Address - Phone:203-640-0385
Mailing Address - Fax:
Practice Address - Street 1:141 DURHAM RD
Practice Address - Street 2:UNIT #15
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2676
Practice Address - Country:US
Practice Address - Phone:203-421-6239
Practice Address - Fax:203-421-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000694213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6682620001OtherMEDICARE DMEPOS PTAN