Fedrigo Podiatry a Professional Corporation
Organization Active NPI Podiatric Clinic/Center · Kentfield, CA
NPI 1790968618 · NPPES record last updated Dec 31, 2024
Key facts
- NPI
- 1790968618
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Podiatric Clinic/Center 261QP1100X
- License
- E4298 (CA)
- Legal business name
- FEDRIGO PODIATRY A PROFESSIONAL CORPORATION
- Practice address
- 1125 Sir Francis Drake Blvd Ste 1
Kentfield, CA 94904-1418 - Phone
- (415) 461-6555
- Fax
- (415) 461-6556
- NPI assigned
- Dec 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Anthony J Fedrigo, DPM
- Title
- DPM
- Phone
- (415) 461-6555
Corporate family (same tax ID) 1
Practitioners 3
-
Oendrila Kamal, D.P.M.
-
Marion Garrett Parke, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110308000672 | CA | Part B Supplier - Clinic/Group Practice | 0648462218 |
Receives reassigned benefits from 2 practitioners Practice locations: Greenbrae, CA |
National Provider Directory
- Tax ID family
- Fedrigo Podiatry
Locations
599 Sir Francis Drake Blvd
Ste 207
Greenbrae, CA 94904
Phone (415) 461-6555
1704 Novato Blvd
Novato, CA 94947
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatric Clinic/Center | 261QP1100X | E4298 | CA | Yes |
Addresses
Primary practice location
1125 Sir Francis Drake Blvd Ste 1
Kentfield, CA 94904-1418
Mailing address
1125 Sir Francis Drake Blvd Ste 1
Kentfield, CA 94904-1418
Phone (415) 461-6555
Other practice location 1
1225 Sir Francis Drake Blvd.
Suite 1
Kentfield, CA 94904
Phone (415) 461-6555
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000E42980 | Other | CA | MEDICARE |
Other providers in Kentfield, CA
- Ariel Elkins
- Diane Holland Engelman
- Jason Sasha Ewbank
- Bert Faerstein
- Balakimwe Farara
- Fedrigo Podiatry, Apc
- Anthony James Fedrigo
- Albert Flood
- Emerson Flores
- Steven Alfred Frankel
All providers in Kentfield, CA · Podiatric Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2024. 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.