Provider Demographics
NPI:1982651733
Name:BOSTON COMMON PODIATRY INC
Entity Type:Organization
Organization Name:BOSTON COMMON PODIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SZPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:617-973-6799
Mailing Address - Street 1:264 BEACON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1236
Mailing Address - Country:US
Mailing Address - Phone:617-262-2266
Mailing Address - Fax:
Practice Address - Street 1:264 BEACON ST
Practice Address - Street 2:SUTIE 201
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1236
Practice Address - Country:US
Practice Address - Phone:617-262-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77335OtherBLUE CROSS/BLUE SHIELD
MA602604OtherTUFTS HEALTH PLAN
MAY78060Medicare PIN