Healthcare Provider Details

I. General information

NPI: 1790061026
Provider Name (Legal Business Name): AFFILIATES IN PODIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PLEASANT ST
CONCORD NH
03301
US

IV. Provider business mailing address

248 PLEASANT ST SUITE 203
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-5281
  • Fax: 603-228-7095
Mailing address:
  • Phone: 603-225-5281
  • Fax: 603-228-7095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM N MCCANN
Title or Position: PRESIDENT/OWNER
Credential: DPM
Phone: 603-225-5281