Auburn Podiatry LLP
Organization Active NPI Podiatrist · Auburn, MA
NPI 1104933209 · NPPES record last updated Feb 2, 2011
Key facts
- NPI
- 1104933209
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatrist 213E00000X
- Legal business name
- AUBURN PODIATRY LLP
- Practice address
- 48 Auburn St
Auburn, MA 01501-2438 - Phone
- (508) 832-6075
- Fax
- (508) 832-9964
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Patricia M Sullivan, DPM
- Title
- Partner
- Phone
- (508) 832-6075
Practitioners 5
-
Maria Bolla, DPM
-
Georgios P Poniros, DPM
-
Najwah Hayman, DPM
-
Derek Cabral, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041216000821 | MA | Part B Supplier - Clinic/Group Practice | 4385601731 |
Receives reassigned benefits from 4 practitioners Practice locations: Auburn, MA; Leominster, MA; Webster, MA |
National Provider Directory
Locations
492 Washington St
Ste 4
Auburn, MA 01501
Phone (774) 772-5161
50 Memorial Dr
Ste 102
Leominster, MA 01453
Phone (508) 534-4414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | Yes |
Addresses
Primary practice location
48 Auburn St
Auburn, MA 01501-2438
Mailing address
48 Auburn St
Auburn, MA 01501-2438
Phone (508) 832-6075
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 642676 | Other | MA | TUFTS GROUP VENDOR NUMBER |
| Y77343 | Other | MA | BS GROUP NUMBER |
| 9749730 | Medicaid | MA |
Other providers in Auburn, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.