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NPI Code Detail

MEDICARE: HEALTHDRIVE PODIATRY GROUP NC, PC

MEDICARE: HEALTHDRIVE PODIATRY GROUP NC, PC
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

General Provider Information

NPI Number : 1629662598
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHDRIVE PODIATRY GROUP NC, PC
Provider Business Mailing Address
First Line : 100 CROSSING BLVD STE 300
Second Line :
City : FRAMINGHAM
State : MA
Zip : 01702-5555
Country : US
Telephone Number : 617-964-6681
Fax Number : 339-686-2561
Provider Business Practice Location Address
First Line : 5960 FAIRVIEW RD STE 300
Second Line :
City : CHARLOTTE
State : NC
Zip : 28210-0202
Country : US
Telephone Number : 888-964-6681
Fax Number : 888-662-0859
Authorized Official
Title or Position : PRESIDENT/PRACTICE DIRECTOR
Name : RONALD TALIS
Credential : DPM
Telephone Number : 857-255-0486
Provider Enumeration Date : 02/22/2021
Last Update Date : 02/22/2021

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