MEDICARE: FIRST STATE PODIATRY, L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E1-0000139	DE

General Provider Information

NPI Number	:	1376600932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STATE PODIATRY, L.L.C.

Provider Business Mailing Address
First Line	:	1177 S GOVERNORS AVE STE B
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-6903
Country	:	US
Telephone Number	:	302-678-4612
Fax Number	:	302-678-4614

Provider Business Practice Location Address
First Line	:	1177 S GOVERNORS AVE STE B
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-6903
Country	:	US
Telephone Number	:	302-678-4612
Fax Number	:	302-678-4614

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. MARCO PAUL HOLGADO
Credential	:	D.P.M.
Telephone Number	:	302-678-4612

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	04/10/2024

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Directions to “FIRST STATE PODIATRY, L.L.C. ” Practice Location

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