1609831023 NPI number — NORTH BRIDGE PODIATRY GROUP, P.C.

Table of content: (NPI 1609831023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609831023 NPI number — NORTH BRIDGE PODIATRY GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BRIDGE PODIATRY GROUP, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609831023
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1732 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01742-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-369-2665
Provider Business Mailing Address Fax Number:
978-371-9914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1732 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-369-2665
Provider Business Practice Location Address Fax Number:
978-371-9914
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CATALANO
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
978-369-2665

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  MA1967 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NOY77264 . This is a "BLUE SHIELD OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 59939 . This is a "FALLON HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 667826 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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