Provider Demographics
NPI:1104933209
Name:AUBURN PODIATRY LLP
Entity type:Organization
Organization Name:AUBURN PODIATRY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-832-6075
Mailing Address - Street 1:48 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2438
Mailing Address - Country:US
Mailing Address - Phone:508-832-6075
Mailing Address - Fax:508-832-9964
Practice Address - Street 1:48 AUBURN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2438
Practice Address - Country:US
Practice Address - Phone:508-832-6075
Practice Address - Fax:508-832-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA642676OtherTUFTS GROUP VENDOR NUMBER
MAY77343OtherBS GROUP NUMBER
MA9749730Medicaid
MAY78067Medicare PIN