Provider Demographics
NPI:1548307564
Name:MILFORD PODIATRY ASSOCIATES, PC
Entity type:Organization
Organization Name:MILFORD PODIATRY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUCIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:508-478-6700
Mailing Address - Street 1:258 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2525
Mailing Address - Country:US
Mailing Address - Phone:508-478-6700
Mailing Address - Fax:508-473-4036
Practice Address - Street 1:258 MAIN ST
Practice Address - Street 2:SUITE 212
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2525
Practice Address - Country:US
Practice Address - Phone:508-478-6700
Practice Address - Fax:508-473-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0307238Medicaid
Y75052Medicare PIN
MAU60204Medicare UPIN
MA6082600001Medicare NSC