Provider Demographics
NPI:1831106988
Name:TALARICO, LEONARD MICHAEL (DPM)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:MICHAEL
Last Name:TALARICO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TRADERS WAY
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4035
Mailing Address - Country:US
Mailing Address - Phone:912-330-8885
Mailing Address - Fax:912-330-8858
Practice Address - Street 1:140 TRADERS WAY
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4035
Practice Address - Country:US
Practice Address - Phone:912-330-8885
Practice Address - Fax:912-330-8858
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA945213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00355897OtherRAILROAD MEDICARE PIN
GA48SCCVDOtherMEDICARE
GA4955111OtherCIGNA
GA52053396005OtherBLUE CROSS BLUE SHIELD
GADF3241OtherMEDICARE RAILROAD GROUP NUMBER
GADF3241OtherRAILROAD MEDICARE GROUP
GA10071146Medicaid
GA0000233650702OtherUNITED HEALTHCARE
GA953027052DMedicaid
GA370807Medicaid
GAU95614Medicare UPIN
GA0000233650702OtherUNITED HEALTHCARE
GAGRP7825Medicare PIN
GA48SCCMCMedicare ID - Type Unspecified
GA5784660001Medicare NSC
GAP00355897Medicare PIN