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General NPI Number Information
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NPI Number | 1942309737
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Entity Type | Organization
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Legal Business Name | MOUSAM VALLEY PODIATRY, P.A.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 10/21/2015
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Provider Practice Location Address
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Address Line | 21 WHITEHALL RD SUITE #302
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City | ROCHESTER
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State | NH
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Zip | 03867-3236
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Country | US
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Telephone | 603-994-7633
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Fax | 603-994-7648
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Provider Business Mailing Address
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Address Line | PO BOX 736
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City | SPRINGVALE
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State | ME
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Zip | 04083-0736
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Country | US
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Telephone | 603-994-7633
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Fax | 603-994-7648
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Authorized Official
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Title or Position | PRESIDENT/PODIATRIST
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Name | SCOTT W GERRY
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Credential | D.P.M.
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Telephone | 603-994-7633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0193
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License Number State | NH
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