Provider Demographics
NPI:1841384963
Name:CHRISTOPHER E. SACCO, DPM, PA
Entity Type:Organization
Organization Name:CHRISTOPHER E. SACCO, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-782-2256
Mailing Address - Street 1:280 MINOT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4867
Mailing Address - Country:US
Mailing Address - Phone:207-782-2256
Mailing Address - Fax:207-514-7651
Practice Address - Street 1:280 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4867
Practice Address - Country:US
Practice Address - Phone:207-782-2256
Practice Address - Fax:207-514-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124970000Medicaid
MEMM5212Medicare PIN