Provider Demographics
NPI:1457407223
Name:MERRIMACK VALLEY PODIATRY PC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PIZZUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-957-9800
Mailing Address - Street 1:1168 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4763
Mailing Address - Country:US
Mailing Address - Phone:978-957-9800
Mailing Address - Fax:978-957-3700
Practice Address - Street 1:1168 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4763
Practice Address - Country:US
Practice Address - Phone:978-957-9800
Practice Address - Fax:978-957-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1904213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA600604OtherTUFTS HEALTH PLAN
MA22256OtherFALLON HEALTH CARE
MAY77130OtherBLUE SHIELD OF MA
MA9761489Medicaid
MA600604OtherTUFTS HEALTH PLAN
MA9761489Medicaid
MA4801680001Medicare NSC