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General NPI Number Information
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NPI Number | 1407681505
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Entity Type | Organization
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Legal Business Name | LUMA PODIATRY & WOUND CARE, PLLC
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Dates
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Enumeration Date | 09/06/2024
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 585 LEBANON ST
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City | MELROSE
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State | MA
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Zip | 02176-3225
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Country | US
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Telephone | 781-979-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 10 GROSVENOR PARK
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City | LYNN
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State | MA
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Zip | 01902-3122
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Country | US
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Telephone | 603-205-4501
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOROTHY HELEN KURTZ PHELAN
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Credential | DPM
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Telephone | 603-205-4501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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