Provider Demographics
NPI:1407933732
Name:PODIATRIC HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:PODIATRIC HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:VAN ESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-744-1309
Mailing Address - Street 1:9 WARREN CT
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3163
Mailing Address - Country:US
Mailing Address - Phone:978-744-1309
Mailing Address - Fax:978-744-3783
Practice Address - Street 1:9 WARREN CT
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3163
Practice Address - Country:US
Practice Address - Phone:978-744-1309
Practice Address - Fax:978-744-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2119213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY78021OtherMEDICARE ID - TYPE UNSPECIFIED
MADH0558OtherRAILROAD MEDICARE
MAY77268OtherBLUE CROSS
MA693801OtherTUFTS
MA9721941Medicaid
MA693801OtherTUFTS