Provider Demographics
NPI:1457341257
Name:GARIBALDI, DOMINICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:GARIBALDI
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2 CHAMBERLAIN AVE UNIT 2
Mailing Address - Street 2:STE 2
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-1021
Mailing Address - Country:US
Mailing Address - Phone:617-846-2609
Mailing Address - Fax:617-846-3513
Practice Address - Street 1:2 CHAMBERLAIN AVE UNIT 2
Practice Address - Street 2:SUITE 2
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-1021
Practice Address - Country:US
Practice Address - Phone:617-846-2609
Practice Address - Fax:617-846-3513
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1786213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0037250OtherNEIGHBORHOOD HEALTH PLAN
MA0972475OtherCIGNA
MA33595OtherHARVARD PILGIM HEALTH CAR
MA0093909OtherAETNA USHC
MAY70802OtherBLUE SHEILD OF MA
MA0361399Medicaid
MA99448201OtherNETWORK HEALTH
MA715076OtherTUFTS HEALTH PLAN
MAT58771Medicare UPIN
MAY70802Medicare PIN
MA0361399Medicaid