Healthcare Provider Details

I. General information

NPI: 1114693900
Provider Name (Legal Business Name): CANDRIA FOOT & ANKLE SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MAIN ST
SOMERVILLE MA
02145-1448
US

IV. Provider business mailing address

25 BUTTRICK RD STE D1
LONDONDERRY NH
03053-3353
US

V. Phone/Fax

Practice location:
  • Phone: 617-629-2806
  • Fax: 617-629-2304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PASQUALE CANCELLIERE
Title or Position: OWNER
Credential: DPM
Phone: 617-629-2806