1013682905 NPI number — CANDRIA FOOT & ANKLE SPECIALISTS PLLC

Table of content: (NPI 1013682905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013682905 NPI number — CANDRIA FOOT & ANKLE SPECIALISTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANDRIA FOOT & ANKLE SPECIALISTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013682905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 BUTTRICK RD STE D1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDONDERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03053-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-216-2972
Provider Business Mailing Address Fax Number:
603-216-5675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 STILES RD STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-328-8437
Provider Business Practice Location Address Fax Number:
603-328-8554
Provider Enumeration Date:
08/12/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CANCELLIERE
Authorized Official First Name:
PASQUALE
Authorized Official Middle Name:
Authorized Official Title or Position:
PODIATRIST, OWNER
Authorized Official Telephone Number:
603-216-2972

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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