Healthcare Provider Details

I. General information

NPI: 1871629162
Provider Name (Legal Business Name): GREATER BOSTON PODIATRY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427B WASHINGTON ST
NORWELL MA
02061-2007
US

IV. Provider business mailing address

427B WASHINGTON ST PO BOX 603
NORWELL MA
02061-2007
US

V. Phone/Fax

Practice location:
  • Phone: 781-659-3443
  • Fax: 781-659-7769
Mailing address:
  • Phone: 781-659-3443
  • Fax: 781-659-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number1727
License Number StateMA

VIII. Authorized Official

Name: DR. THOMAS WILLIAM VORDERER
Title or Position: PRESIDENT
Credential: DPM
Phone: 781-659-3443