Healthcare Provider Details

I. General information

NPI: 1649619776
Provider Name (Legal Business Name): NORTHERN OHIO FOOT AND ANKLE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E MAIN ST
NEW LONDON OH
44851-1201
US

IV. Provider business mailing address

111 E MAIN ST
NEW LONDON OH
44851-1201
US

V. Phone/Fax

Practice location:
  • Phone: 419-929-6222
  • Fax: 419-660-0098
Mailing address:
  • Phone: 419-929-6222
  • Fax: 419-660-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARC D DOLCE
Title or Position: OWNER
Credential: DPM
Phone: 419-660-0099