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NPI Code Detail

MEDICARE: PALMETTO PODIATRY P.A.

MEDICARE: PALMETTO PODIATRY P.A.
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
1213E00000XPodiatrist990131SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760547848
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALMETTO PODIATRY P.A.
Provider Business Mailing Address
First Line : 1220A HOSPITAL DR
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-3678
Country : US
Telephone Number : 843-881-9159
Fax Number : 843-971-1105
Provider Business Practice Location Address
First Line : 1220A HOSPITAL DR
Second Line :
City : MOUNT PLEASANT
State : SC
Zip : 29464-3251
Country : US
Telephone Number : 843-881-9159
Fax Number : 843-971-1105
Authorized Official
Title or Position : PRESIDENT DOCTOR
Name : DR. JOHN R MARINO
Credential : D.P.M.
Telephone Number : 843-881-9159
Provider Enumeration Date : 12/27/2006
Last Update Date : 01/05/2010

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Directions to “PALMETTO PODIATRY P.A. ” Practice Location

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