Healthcare Provider Details

I. General information

NPI: 1609059187
Provider Name (Legal Business Name): PALMER PODIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SOCIETY DR
CLAYMONT DE
19703-1782
US

IV. Provider business mailing address

10 BASSWOOD LN
WILMINGTON DE
19810-1927
US

V. Phone/Fax

Practice location:
  • Phone: 302-792-1961
  • Fax: 302-792-1981
Mailing address:
  • Phone: 302-475-6879
  • Fax: 302-792-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberE1-0000131
License Number StateDE

VIII. Authorized Official

Name: DR. MELONIE ROMINA PALMER
Title or Position: PODIATRIST/OWNER
Credential: D.P.M.
Phone: 302-792-1961