Healthcare Provider Details

I. General information

NPI: 1609831023
Provider Name (Legal Business Name): NORTH BRIDGE PODIATRY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 MAIN ST
CONCORD MA
01742-3837
US

IV. Provider business mailing address

1732 MAIN ST
CONCORD MA
01742-3837
US

V. Phone/Fax

Practice location:
  • Phone: 978-369-2665
  • Fax: 978-371-9914
Mailing address:
  • Phone: 978-369-2665
  • Fax: 978-371-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberMA1967
License Number StateMA

VIII. Authorized Official

Name: GREGORY D. CATALANO
Title or Position: OWNER
Credential: D.P.M.
Phone: 978-369-2665