Provider Demographics
NPI:1609831023
Name:NORTH BRIDGE PODIATRY GROUP, P.C.
Entity Type:Organization
Organization Name:NORTH BRIDGE PODIATRY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CATALANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-369-2665
Mailing Address - Street 1:1732 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3837
Mailing Address - Country:US
Mailing Address - Phone:978-369-2665
Mailing Address - Fax:978-371-9914
Practice Address - Street 1:1732 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3837
Practice Address - Country:US
Practice Address - Phone:978-369-2665
Practice Address - Fax:978-371-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1967213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANOY77264OtherBLUE SHIELD OF MA
MA59939OtherFALLON HEALTH PLAN
MA667826OtherTUFTS HEALTH PLAN
MA667826OtherTUFTS HEALTH PLAN
MA59939OtherFALLON HEALTH PLAN
MAT95957Medicare UPIN