Provider Demographics
NPI:1275519365
Name:METHUEN PODIATRY ASSOCIATES LLP
Entity Type:Organization
Organization Name:METHUEN PODIATRY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-682-0382
Mailing Address - Street 1:191 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-3837
Mailing Address - Country:US
Mailing Address - Phone:978-682-0382
Mailing Address - Fax:978-975-3585
Practice Address - Street 1:191 BROADWAY
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-3837
Practice Address - Country:US
Practice Address - Phone:978-682-0382
Practice Address - Fax:978-975-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y77357OtherBLUE CROSS OF MASS
119448OtherHEALTH PARTNERS,MULTI PLANS
MA9756680Medicaid
202669700OtherUSP DEPART OF LABOR
629OtherSENIOR WHOLE HEALTH
0039719OtherNEIGHBORHOOD HEALTH PLANS
5190491OtherAETNA
DF6168OtherMEDICARE RAILROAD
724027OtherTUFTS HMO.PPO
119448OtherHEALTH PARTNERS,MULTI PLANS
MA5762820001Medicare NSC