Provider Demographics
NPI:1851835268
Name:FOOT HEALTH CENTER OF MERRIMACK VALLEY-WPHO PC
Entity Type:Organization
Organization Name:FOOT HEALTH CENTER OF MERRIMACK VALLEY-WPHO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTOFT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-423-9581
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:978-686-7623
Mailing Address - Fax:978-683-9911
Practice Address - Street 1:451 ANDOVER ST
Practice Address - Street 2:SUITE 209
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5044
Practice Address - Country:US
Practice Address - Phone:978-686-7623
Practice Address - Fax:978-683-9911
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOOT HEALTH CENTER OF MERRIMACK VALLEY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4629520001Medicare NSC
MA0010668Medicare PIN