Provider Demographics
NPI:1841388709
Name:CIAVARELLI, LINDA (DPM)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:CIAVARELLI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N BANCROFT PKWY
Mailing Address - Street 2:SUITE 12
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2690
Mailing Address - Country:US
Mailing Address - Phone:302-658-1129
Mailing Address - Fax:302-658-7646
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:SUITE 12
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-658-1129
Practice Address - Fax:302-658-7646
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000177213ES0103X
PASC005825213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA106156PUPMedicare ID - Type Unspecified
V11003Medicare UPIN
DE020757A46Medicare ID - Type Unspecified