Provider Demographics
NPI:1679176663
Name:PEABODY PODIATRY LLC
Entity Type:Organization
Organization Name:PEABODY PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PEICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-531-9969
Mailing Address - Street 1:6 ESSEX CENTER DR STE 208
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2906
Mailing Address - Country:US
Mailing Address - Phone:978-531-9969
Mailing Address - Fax:
Practice Address - Street 1:6 ESSEX CENTER DR STE 208
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2906
Practice Address - Country:US
Practice Address - Phone:978-531-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty