Provider Demographics
NPI:1962034561
Name:AZURE HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:AZURE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-953-7033
Mailing Address - Street 1:10 NETHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1234
Mailing Address - Country:US
Mailing Address - Phone:617-953-7033
Mailing Address - Fax:
Practice Address - Street 1:10 NETHERWOOD RD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1234
Practice Address - Country:US
Practice Address - Phone:617-953-7033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty