Provider Demographics
NPI:1396492104
Name:MINIMALLY INVASIVE PODIATRY LLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:CHARBONNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-230-3629
Mailing Address - Street 1:322 PEARL STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4762
Mailing Address - Country:US
Mailing Address - Phone:267-230-3629
Mailing Address - Fax:
Practice Address - Street 1:322 PEARL STREET
Practice Address - Street 2:STE 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4762
Practice Address - Country:US
Practice Address - Phone:267-230-3629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty