Healthcare Provider Details

I. General information

NPI: 1073978987
Provider Name (Legal Business Name): BEVERLY PODIATRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CUMMINGS CTR SUITE 309V
BEVERLY MA
01915-6198
US

IV. Provider business mailing address

900 CUMMINGS CTR SUITE 309V
BEVERLY MA
01915-6198
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-0288
  • Fax: 978-927-6265
Mailing address:
  • Phone: 978-922-0288
  • Fax: 978-927-6265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1930
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1930
License Number StateMA

VIII. Authorized Official

Name: DR. TIMOTHY J TOBIN
Title or Position: OWNER
Credential: DPM
Phone: 978-922-0288