Healthcare Provider Details

I. General information

NPI: 1477984185
Provider Name (Legal Business Name): LEGACY FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 CONCORD AVE SUITE 3600
CAMBRIDGE MA
02138-1040
US

IV. Provider business mailing address

123 MAYNARD FARM RD
SUDBURY MA
01776-1012
US

V. Phone/Fax

Practice location:
  • Phone: 617-354-3131
  • Fax: 617-354-2657
Mailing address:
  • Phone: 617-923-3998
  • Fax: 617-321-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2328
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number2327
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number2328
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2327
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number2328
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number2327
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License Number2328
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number2327
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number2328
License Number StateMA
# 10
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2327
License Number StateMA
# 11
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2328
License Number StateMA
# 12
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2327
License Number StateMA
# 13
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2328
License Number StateMA
# 14
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2327
License Number StateMA

VIII. Authorized Official

Name: DR. EMILY ANNE COOK
Title or Position: MEMBER/PHYSICIAN
Credential: D.P.M., M.P.H.
Phone: 617-354-3131