Provider Demographics
NPI:1881233138
Name:MALDEN PODIATRY LLC
Entity Type:Organization
Organization Name:MALDEN PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEXLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-324-8704
Mailing Address - Street 1:58 BUCKMAN DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6040
Mailing Address - Country:US
Mailing Address - Phone:781-862-9393
Mailing Address - Fax:781-862-7077
Practice Address - Street 1:58 BUCKMAN DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6040
Practice Address - Country:US
Practice Address - Phone:781-862-9393
Practice Address - Fax:781-862-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-04
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty