Healthcare Provider Details

I. General information

NPI: 1982651733
Provider Name (Legal Business Name): BOSTON COMMON PODIATRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 BEACON ST SUTIE 201
BOSTON MA
02116-1236
US

IV. Provider business mailing address

264 BEACON ST SUITE 201
BOSTON MA
02116-1236
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2266
  • Fax:
Mailing address:
  • Phone: 617-262-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JORDANA SZPIRO
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 617-973-6799