Provider Demographics
NPI:1932133006
Name:SHORELINE PODIATRY, INC
Entity Type:Organization
Organization Name:SHORELINE PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:I
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-783-2424
Mailing Address - Street 1:24 SALT POND RD
Mailing Address - Street 2:UNIT E-1
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-4314
Mailing Address - Country:US
Mailing Address - Phone:401-783-2424
Mailing Address - Fax:401-789-2095
Practice Address - Street 1:24 SALT POND RD
Practice Address - Street 2:UNIT E-1
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4314
Practice Address - Country:US
Practice Address - Phone:401-783-2424
Practice Address - Fax:401-789-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1909AOtherNEIGHBORHOOD HEALTH
RIPT SS#-TAX ID#204928OtherRAILROAD MEDICARE
RI1358102OtherAETNA HMO
RI9004977Medicaid
RI1358102OtherAETNA COMMERCIAL
RI=========OtherBCBS OF RI
RIPT SS#-TAX ID#204928OtherRAILROAD MEDICARE
RI=========OtherHARVARD PILGRIM
RI9004977Medicaid
RI1358102OtherAETNA HMO
RI=========OtherBLUE CHIP OF RI
RI=========OtherCIGNA
RI=========OtherHARVARD PILGRIM
RI489004977Medicare PIN