Provider Demographics
NPI:1760693261
Name:JEWETT PODIATRY CENTER
Entity Type:Organization
Organization Name:JEWETT PODIATRY CENTER
Other - Org Name:FREDERIC C. JEWETT D.P.M.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-774-2628
Mailing Address - Street 1:7 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3620
Mailing Address - Country:US
Mailing Address - Phone:978-774-2628
Mailing Address - Fax:978-774-4050
Practice Address - Street 1:7 FEDERAL ST
Practice Address - Street 2:SUITE 33
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3620
Practice Address - Country:US
Practice Address - Phone:978-774-2628
Practice Address - Fax:978-774-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1718213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA719796Medicare UPIN
MA1041200001Medicare NSC