Provider Demographics
NPI:1962439240
Name:NORTHERN PODIATRY ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN PODIATRY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:671-983-1900
Mailing Address - Street 1:1153 CENTER STREET
Mailing Address - Street 2:SUITE 5980
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3446
Mailing Address - Country:US
Mailing Address - Phone:617-983-1900
Mailing Address - Fax:617-983-8122
Practice Address - Street 1:1153 CENTRE ST
Practice Address - Street 2:SUITE 5980
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-3446
Practice Address - Country:US
Practice Address - Phone:617-983-1900
Practice Address - Fax:617-983-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2428484OtherAETNA
611767OtherTUFTS
Y77179OtherBLUE SHIELD
Y77179OtherBLUE SHIELD
MA1162630002Medicare NSC