Provider Demographics
NPI:1073978987
Name:BEVERLY PODIATRY INC.
Entity Type:Organization
Organization Name:BEVERLY PODIATRY INC.
Other - Org Name:TIMOTHY TOBIN D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-922-0288
Mailing Address - Street 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 309V
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-922-0288
Mailing Address - Fax:978-927-6265
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 309V
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-922-0288
Practice Address - Fax:978-927-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1930213ES0131X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY70922Medicare PIN