BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES PODIATRY DIVISION (NPI# 1962686329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962686329 |
| Entity Type | Organization |
| Organization Name | BRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES PODIATRY DIVISION |
| Other Organization Name | SIGNATURE MEDICAL GROUP |
| Practice Address |
110 Liberty St Brockton MA 02301-5521 |
| Practice Telephone | 5088940400 |
| Practice Fax Number | 5085650157 |
| Mailing Telephone | 5088940400 |
| Mailing Fax Number | 5085650157 |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2012-05-23 |
| Authorized Official Name | MR. KIM HOLLON (CEO) |
| Authorized Official Telephone | 5089417004 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213ES0131X |
Podiatrist Specialization: Foot Surgery |
1715 | MA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MA | 110022141E | 05 |
| Other Name | Type Code |
|---|---|
| Signature Medical Group | Doing Business As Name - Organization |
| Street Address |
110 LIBERTY ST |
| City | BROCKTON |
| State | MA |
| Zip Code | 02301-5521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164416186 | Aqeel Siddiqui | Surgery | 110 Liberty St, Brockton, MA 02301-5521 | 2005-09-06 |
| 1902404981 | Sara Louise Borrello | Dietitian, Registered | 110 Liberty St, Brockton, MA 02301-5674 | 2020-10-13 |
| 1134735392 | Meredith Celine Harrington | Physical Medicine & Rehabilitation | 110 Liberty St, Brockton, MA 02301-5674 | 2020-09-22 |
| 1356951784 | Adam S Donahue | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5674 | 2020-07-31 |
| 1427603851 | Kristen Laura Barrett | Registered Nurse | 110 Liberty St, Brockton, MA 02301-5674 | 2019-08-02 |
| 1427611722 | Donovan Kelly | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5674 | 2019-04-22 |
| 1316411481 | Cassandra Desjardins | Nurse Practitioner | 110 Liberty St, Brockton, MA 02301-5521 | 2019-01-11 |
| 1407353154 | Dean Robert Howell | Social Worker | 110 Liberty St, Brockton, MA 02301-5674 | 2018-04-10 |
| 1619473725 | Patricia L Ramanauskas | Technician/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2018-04-05 |
| 1588182323 | Alicia Reid | Specialist/Technologist | 110 Liberty St, Brockton, MA 02301-5521 | 2017-08-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942807110 | Jenny Vulpis | Recreation Therapist | 940 Belmont St (br 135), Brockton, MA 02301 | 2020-10-01 |
| 1205444924 | Caroline Storey | Counselor | Men's Addiction Treatment Center, 10 Meadowbrook Road, Brockton, MA 02301 | 2020-07-20 |
| 1013546852 | Nuria Dos Santos Veiga | Occupational Therapist | 73 Denton St, Brockton, MA 02301 | 2020-04-03 |
| 1679113930 | Laura Ann Brondyk II | Counselor | 10 Christys Dr, Brockton, MA 02301 | 2020-01-14 |
| 1437796521 | Andrea Lopes | Developmental Therapist | 7 Goddard Road, Brockton, MA 02301 | 2019-12-08 |
| 1518420124 | Diligencehealthcare | Psychiatry & Neurology | 30-40 Westpark Street, Brockton, MA 02301 | 2019-04-10 |
| 1124530373 | Rachel Theys | Behavioral Analyst | 130 Liberty St Ste 13a, Brockton, MA 02301 | 2017-10-27 |
| 1689193369 | Anderson D Delgado | Behavior Technician | 11 Packard Way, Brockton, MA 02301 | 2017-09-14 |
| 1811415326 | Francesca Lavecchia | Clinical Neuropsychologist | Brockto Area Multi Service, Inc. 10 Christy Dr., Brockton, MA 02301 | 2017-09-05 |
| 1831615343 | Donna Marie Dugan | Counselor | South Bay Community Services, 340 Main Street - Suite 818, Worcester, MA 02301 | 2017-08-16 |
| Find all providers in zip 02301 | ||||
| Taxonomy Code | 213ES0131X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629294020 | J W Podiatry PC | Podiatrist | 22 Christy Dr, 5, Brockton, MA 02301-1839 | 2007-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043746878 | Faezeh Bakhtiari-nejad | Podiatrist | 223 Concord Tpke Unit 219, Cambridge, MA 02140-2338 | 2017-05-11 |
| 1679966584 | Melrose Family Foot Care Group | Podiatrist | 533 Franklin St, Melrose, MA 02176-1742 | 2015-03-17 |
| 1366795023 | Matthew P. Butler, D.p.m. LLC | Podiatrist | 1153 Centre Street, Suite # 5980, Brigham and Women's Faulkner Hospital, Boston, MA 02130 | 2012-10-18 |
| 1518141035 | Richard S. Donela | Podiatrist | 900 State Rd, North Adams, MA 01247-3030 | 2007-12-19 |
| 1962685396 | Cecilia G. Moore Dpm LLC | Podiatrist | 214 Orleans Rd, Suite C, North Chatham, MA 02650-3101 | 2007-12-07 |
| 1932145810 | Mark Paul Sanphy | Podiatrist | 98 Nahant St, Lynn, MA 01902-3315 | 2006-06-21 |
| 1154385078 | Matthew P Butler | Podiatrist | 340 Maple Street, Suite 405, Marlborough, MA 01752 | 2006-04-17 |
| 1083675573 | Susan M Walsh | Podiatrist | 981 Canton Ave, Milton, MA 02186-3621 | 2006-04-01 |
| 1316914971 | Bruce Treadwell Croft | Podiatrist | 795 Main St, Holden, MA 01520-3800 | 2006-03-02 |
| 1255301891 | James Gerard Cataldo | Podiatrist | 14 Manning Ave, Suite 302, Leominster, MA 01453-5768 | 2006-01-25 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.