Healthcare Provider Details

I. General information

NPI: 1912056607
Provider Name (Legal Business Name): TOTAL FOOT CARE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W 18TH ST
WILMINGTON DE
19802-4707
US

IV. Provider business mailing address

607 W 18TH ST
WILMINGTON DE
19802-4707
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-5601
  • Fax:
Mailing address:
  • Phone: 302-652-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0000086
License Number StateDE

VIII. Authorized Official

Name: DR. ALEXANDER TERRIS
Title or Position: PRESIDENT
Credential: DPM
Phone: 302-652-5601