Provider Demographics
NPI:1689613598
Name:HEALTHDRIVE PODIATRY GROUP, PC
Entity Type:Organization
Organization Name:HEALTHDRIVE PODIATRY GROUP, PC
Other - Org Name:HEALTHDRIVE PODIATRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PRACTICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTOMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:857-255-0486
Mailing Address - Street 1:100 CROSSING BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-5555
Mailing Address - Country:US
Mailing Address - Phone:617-964-6681
Mailing Address - Fax:339-686-2561
Practice Address - Street 1:655 METRO PL S STE 600
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3394
Practice Address - Country:US
Practice Address - Phone:888-964-6681
Practice Address - Fax:888-662-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41738600Medicaid
MAY77147OtherBLUE CROSS BLUE SHIELD
MD423718800Medicaid
MA9769536Medicaid
MACI9828OtherMEDICARE RAILROAD
MA4864220002Medicare NSC
MA9769536Medicaid