Healthcare Provider Details

I. General information

NPI: 1982176806
Provider Name (Legal Business Name): NPA CAPE ANN FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BLACKBURN CTR
GLOUCESTER MA
01930-2259
US

IV. Provider business mailing address

5 BLACKBURN CTR
GLOUCESTER MA
01930-2259
US

V. Phone/Fax

Practice location:
  • Phone: 978-281-2550
  • Fax: 978-325-9044
Mailing address:
  • Phone: 978-281-2550
  • Fax: 978-325-9044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SARAH DIMAMBRO
Title or Position: MANAGER
Credential:
Phone: 781-762-4205