Individual
DR. EVERETT JOHN VANDERPOOL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 OCEAN AVE, REVERE HEALTHCARE CENTER, REVERE, MA 02151-3675
(781) 485-6316
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
202747
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0107760
—
MA
01
—
202747
TUFTS HEALTH PLAN
MA
01
—
J22872
BCBS MA
MA
Enumeration date
04/04/2006
Last updated
07/08/2007
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