MARK ANTHONY BOISSONNEAULT NPI 1508493248

NPI Information

NPI: 1508493248
Provider Name: MARK ANTHONY BOISSONNEAULT
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

PECOS Registration: Yes

Address:
22 OLD RUDNICK LANE
DOVER, DE
ZIP 19901
Phone: (302) 674-9255
Get Directions

Mark Anthony Boissonneault is a foot and ankle surgery podiatrist in Dover, DE. Mark Anthony Boissonneault NPI is 1508493248. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

22 OLD RUDNICK LANE
DOVER, DE
ZIP 19901
Phone: (302) 674-9255
Fax: (302) 674-9096

The NPI 1508493248 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 3/24/2020 and was last updated on 8/31/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	213ES0103X	Podiatrist	Foot & Ankle Surgery	E1-0010279	DELAWARE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0000827650	MEDICAID	DELAWARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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