Provider Demographics
NPI:1649365586
Name:FOOT HEALTHCARE OF DELAWARE, INC.
Entity type:Organization
Organization Name:FOOT HEALTHCARE OF DELAWARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:302-765-2505
Mailing Address - Street 1:PO BOX 9551
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-0551
Mailing Address - Country:US
Mailing Address - Phone:302-765-2505
Mailing Address - Fax:302-765-2090
Practice Address - Street 1:2323 PENNSYLVANIA AVE STE 2B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1332
Practice Address - Country:US
Practice Address - Phone:302-765-2505
Practice Address - Fax:302-384-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001069450Medicaid
DE3960940001Medicare NSC
DE0001069450Medicaid