Provider Demographics
NPI:1871629162
Name:GREATER BOSTON PODIATRY ASSOCIATES, PC
Entity Type:Organization
Organization Name:GREATER BOSTON PODIATRY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:VORDERER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-659-3443
Mailing Address - Street 1:427B WASHINGTON ST
Mailing Address - Street 2:PO BOX 603
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-2007
Mailing Address - Country:US
Mailing Address - Phone:781-659-3443
Mailing Address - Fax:781-659-7769
Practice Address - Street 1:427B WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-2007
Practice Address - Country:US
Practice Address - Phone:781-659-3443
Practice Address - Fax:781-659-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1727213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0357782Medicaid
MA360996Medicaid
MAY70771OtherBLUE CROSS BLUE SHEILD
MAY77303OtherBLUE CROSS GROUP NUMBER
MA9713565Medicaid
MA9713565Medicaid
MAYY7127Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MAY70954Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MA4601280001Medicare NSC
MA0357782Medicaid
MA360996Medicaid