Provider Demographics
NPI:1801829122
Name:VORDERER, THOMAS W (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:VORDERER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2210
Mailing Address - Country:US
Mailing Address - Phone:781-659-9866
Mailing Address - Fax:
Practice Address - Street 1:319 LONGWOOD AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5728
Practice Address - Country:US
Practice Address - Phone:617-355-3501
Practice Address - Fax:617-730-0178
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1727213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0360996Medicaid
YY712701Medicare PIN
MA0360996Medicaid