Healthcare Provider Details

I. General information

NPI: 1245275114
Provider Name (Legal Business Name): PIONEER PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEST ST
W HATFIELD MA
01088-9554
US

IV. Provider business mailing address

10 WEST ST
W HATFIELD MA
01088-9554
US

V. Phone/Fax

Practice location:
  • Phone: 413-397-8900
  • Fax: 413-247-6151
Mailing address:
  • Phone: 413-397-8900
  • Fax: 413-247-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2161
License Number StateMA

VIII. Authorized Official

Name: DR. LOUIS JAMES DECARO
Title or Position: PRESIDENT, CEO
Credential: D.P.M.
Phone: 413-397-8900