Provider Demographics
NPI:1134260169
Name:CAMBRIDGE PODIATRY NETWORK PC
Entity type:Organization
Organization Name:CAMBRIDGE PODIATRY NETWORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-396-8737
Mailing Address - Street 1:425 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3337
Mailing Address - Country:US
Mailing Address - Phone:781-396-8737
Mailing Address - Fax:781-395-8197
Practice Address - Street 1:425 SALEM ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3337
Practice Address - Country:US
Practice Address - Phone:781-396-8737
Practice Address - Fax:781-395-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1793213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711121Medicaid
MA9711121Medicaid
T31803Medicare UPIN