Healthcare Provider Details

I. General information

NPI: 1518325281
Provider Name (Legal Business Name): FRANK S. CAMPO, D.P.M.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NORTH ST
BOSTON MA
02113-2106
US

IV. Provider business mailing address

260 NORTH ST
BOSTON MA
02113-2106
US

V. Phone/Fax

Practice location:
  • Phone: 617-248-8682
  • Fax: 617-248-0319
Mailing address:
  • Phone: 617-248-8682
  • Fax: 617-248-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number1907
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number1907
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1907
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1907
License Number StateMA

VIII. Authorized Official

Name: DR. FRANK S CAMPO
Title or Position: OWNER/PODIATRIST
Credential: D.P.M.
Phone: 617-248-8682