Healthcare Provider Details

I. General information

NPI: 1437347754
Provider Name (Legal Business Name): MILFORD PODIATRY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CHERRY ST
MILFORD CT
06460-3429
US

IV. Provider business mailing address

32 CHERRY ST
MILFORD CT
06460-3429
US

V. Phone/Fax

Practice location:
  • Phone: 203-874-6755
  • Fax: 203-877-7849
Mailing address:
  • Phone: 203-874-6755
  • Fax: 203-877-7849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA ALLEN
Title or Position: CREDENTIALLING COORDINATOR
Credential:
Phone: 203-874-6755