Provider Demographics
NPI:1790882751
Name:MEADOWS PODIATRY PC
Entity Type:Organization
Organization Name:MEADOWS PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:FILIPPI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:413-525-4311
Mailing Address - Street 1:313 MAPLE STREET
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028
Mailing Address - Country:US
Mailing Address - Phone:413-525-4311
Mailing Address - Fax:413-525-4314
Practice Address - Street 1:313 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-525-4311
Practice Address - Fax:413-525-4314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2101213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9733311Medicaid
MAY77341OtherBCBS OF MASS
MA641443OtherTUFTS
MA9733311Medicaid
MAY78065Medicare ID - Type Unspecified
MA5126430001Medicare NSC