Provider Demographics
NPI:1508155797
Name:METHUEN PODIATRY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:METHUEN PODIATRY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:DAVID
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?:Yes
Parent Organization LBN:METHUEN PODIATRY ASSOCIATES, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1567213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9756680Medicaid
MAY78072Medicare PIN