Provider Demographics
NPI:1679966584
Name:MELROSE FAMILY FOOT CARE GROUP
Entity Type:Organization
Organization Name:MELROSE FAMILY FOOT CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SENNEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-665-4625
Mailing Address - Street 1:533 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-665-4625
Mailing Address - Fax:781-665-0090
Practice Address - Street 1:533 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1742
Practice Address - Country:US
Practice Address - Phone:781-665-4625
Practice Address - Fax:781-665-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1776213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9774149Medicaid