Healthcare Provider Details

I. General information

NPI: 1801829122
Provider Name (Legal Business Name): THOMAS W VORDERER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 LONGWOOD AVE 6TH FLOOR
BOSTON MA
02115-5728
US

IV. Provider business mailing address

228 RIVER ST
NORWELL MA
02061-2210
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-3501
  • Fax: 617-730-0178
Mailing address:
  • Phone: 781-659-9866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1727
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: