Healthcare Provider Details

I. General information

NPI: 1477737427
Provider Name (Legal Business Name): ANKLE AND FOOT CARE CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 FOX LANE
CHESTER WV
26034
US

IV. Provider business mailing address

8175 MARKET ST
YOUNGSTOWN OH
44512-6244
US

V. Phone/Fax

Practice location:
  • Phone: 330-385-2413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAWRENCE DIDOMENICO
Title or Position: DPM
Credential: DPM
Phone: 330-629-8800