Basic Information
Provider Information
NPI: 1003141029
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAPPALARDO
FirstName: JENNIFER
MiddleName: LYNNE
NamePrefix: DR.
NameSuffix:  
Credential: DPM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5300 E ERICKSON DR STE 118
Address2: SUITE 112
City: TUCSON
State: AZ
PostalCode: 857122809
CountryCode: US
TelephoneNumber: 5203266766
FaxNumber: 5207401949
Practice Location
Address1: 123 SUMMER ST
Address2: DEPARTMENT OF PODIATRY
City: WORCESTER
State: MA
PostalCode: 016081216
CountryCode: US
TelephoneNumber: 5083637390
FaxNumber: 5083637560
Other Information
ProviderEnumerationDate: 10/08/2009
LastUpdateDate: 07/12/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
213ES0103X0751AZY Podiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery

No ID Information.


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