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General NPI Number Information
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NPI Number | 1093947111
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Entity Type | Organization
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Legal Business Name | LAKE PODIATRY, P.A.
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 144 HIGHLAND ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1240
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Country | US
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Telephone | 603-536-4563
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Fax | 603-536-1056
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Provider Business Mailing Address
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Address Line | 144 HIGHLAND ST
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City | PLYMOUTH
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State | NH
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Zip | 03264-1240
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Country | US
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Telephone | 603-536-4563
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Fax | 603-536-1056
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MATTHEW L BURRELL
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Credential | D.P.M.
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Telephone | 603-536-4563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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