Healthcare Provider Details

I. General information

NPI: 1467096701
Provider Name (Legal Business Name): BOARD CERTIFIED FOOTCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 TURNPIKE RD
SOUTHBOROUGH MA
01772-2110
US

IV. Provider business mailing address

140 PARK ST STE 1
ATTLEBORO MA
02703-8048
US

V. Phone/Fax

Practice location:
  • Phone: 508-226-8070
  • Fax:
Mailing address:
  • Phone: 508-226-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MS. PATRICIA MCLAUGHLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-226-8070