Provider Demographics
NPI:1669551958
Name:PODIATRY HEALTHCARE P.C.
Entity type:Organization
Organization Name:PODIATRY HEALTHCARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:JHAVERI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-304-8403
Mailing Address - Street 1:PO BOX 520569
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-0010
Mailing Address - Country:US
Mailing Address - Phone:617-539-0197
Mailing Address - Fax:617-539-0669
Practice Address - Street 1:480 MAPLE ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-4065
Practice Address - Country:US
Practice Address - Phone:978-304-8403
Practice Address - Fax:978-304-8493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD 2177213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77368OtherBCBS
MAAA83050OtherHARVARD PILGRIM
MA650236OtherTUFTS