Provider Demographics
NPI:1528242971
Name:SUSAN DORRY PODIATRIC MEDICINE AND SURGERY
Entity type:Organization
Organization Name:SUSAN DORRY PODIATRIC MEDICINE AND SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-291-0699
Mailing Address - Street 1:268 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-2172
Mailing Address - Country:US
Mailing Address - Phone:508-291-0699
Mailing Address - Fax:508-291-0690
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-2172
Practice Address - Country:US
Practice Address - Phone:508-291-0699
Practice Address - Fax:508-291-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2071213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5445530001Medicare NSC