Healthcare Provider Details

I. General information

NPI: 1932133006
Provider Name (Legal Business Name): SHORELINE PODIATRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SALT POND RD UNIT E-1
WAKEFIELD RI
02879-4314
US

IV. Provider business mailing address

24 SALT POND RD UNIT E-1
WAKEFIELD RI
02879-4314
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-2424
  • Fax: 401-789-2095
Mailing address:
  • Phone: 401-783-2424
  • Fax: 401-789-2095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAMES I MCCORMICK
Title or Position: PRESIDENT
Credential:
Phone: 401-783-2424