Provider Demographics
NPI:1013901628
Name:CESA, KENNETH G (DPM)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:G
Last Name:CESA
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 1:290 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1944
Mailing Address - Country:US
Mailing Address - Phone:978-927-0600
Mailing Address - Fax:978-927-0600
Practice Address - Street 1:290 ESSEX ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1944
Practice Address - Country:US
Practice Address - Phone:978-927-0600
Practice Address - Fax:978-927-0600
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA 1622213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CEY70699OtherBCBS
MA0341401Medicaid
CEY70699OtherBCBS
MA480000527Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MA0341401Medicaid