Healthcare Provider Details

I. General information

NPI: 1780979732
Provider Name (Legal Business Name): JOHN A. MACLEOD DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HANOVER ST
FALL RIVER MA
02720-5246
US

IV. Provider business mailing address

925 RESERVOIR AVE
CRANSTON RI
02910-4436
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-7778
  • Fax:
Mailing address:
  • Phone: 401-714-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1775
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN A. MACLEOD
Title or Position: OWNER
Credential: DPM
Phone: 401-714-6997