Healthcare Provider Details

I. General information

NPI: 1811905169
Provider Name (Legal Business Name): EAST PROVIDENCE FOOTCARE,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 TAUNTON AVE
EAST PROVIDENCE RI
02914-3731
US

IV. Provider business mailing address

PO BOX 3160
ANDOVER MA
01810-0803
US

V. Phone/Fax

Practice location:
  • Phone: 401-438-8090
  • Fax: 401-435-5069
Mailing address:
  • Phone: 978-474-8885
  • Fax: 978-474-8845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPMO198
License Number StateRI

VIII. Authorized Official

Name: DENNIS ANTHONY DIMATTEO
Title or Position: PRESIDENT
Credential: DPM
Phone: 401-438-8090