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NPI Code Detail

MEDICARE: ACTIVE ANKLE & FOOT CENTER PLLC

MEDICARE: ACTIVE ANKLE & FOOT CENTER PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ACTI00068638OTHERVERMONT BCBS
2610830200OTHERDEPT OF LABOR

General Provider Information

NPI Number : 1093726291
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACTIVE ANKLE & FOOT CENTER PLLC
Provider Business Mailing Address
First Line : PO BOX 2200
Second Line :
City : AMHERST
State : NH
Zip : 03031-4200
Country : US
Telephone Number : 603-673-9411
Fax Number : 603-673-9899
Provider Business Practice Location Address
First Line : 251 ELM ST
Second Line : SUITE #3
City : CLAREMONT
State : NH
Zip : 03743-4921
Country : US
Telephone Number : 603-543-3668
Fax Number : 603-543-9552
Authorized Official
Title or Position : OWNER
Name : JOHN B GREGORY
Credential : DPM
Telephone Number : 603-543-3668
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/30/2009

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Directions to “ACTIVE ANKLE & FOOT CENTER PLLC ” Practice Location

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