=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871629162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREATER BOSTON PODIATRY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 04/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 427B WASHINGTON ST
-----------------------------------------------------
City | NORWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02061-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-659-3443
-----------------------------------------------------
Fax | 781-659-7769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 427B WASHINGTON ST PO BOX 603
-----------------------------------------------------
City | NORWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02061-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-659-3443
-----------------------------------------------------
Fax | 781-659-7769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. THOMAS WILLIAM VORDERER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 781-659-3443
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0000X
-----------------------------------------------------
Taxonomy Name | Sports Medicine Podiatrist
-----------------------------------------------------
License Number | 1727
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------