Provider Demographics
NPI:1982774998
Name:ADVANCED FOOT CARE, INC.
Entity Type:Organization
Organization Name:ADVANCED FOOT CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-934-8447
Mailing Address - Street 1:95 TREMONT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-4738
Mailing Address - Country:US
Mailing Address - Phone:781-934-8447
Mailing Address - Fax:781-934-8446
Practice Address - Street 1:95 TREMONT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-4738
Practice Address - Country:US
Practice Address - Phone:781-934-8447
Practice Address - Fax:781-934-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2066213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX20272Medicare UPIN