Individual
DR. JEFFREY S GORODETSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
165 MILL ST, LEOMINSTER, MA 01453-3289
(978) 466-3212
(978) 534-3581
Mailing address
630 PLANTATION ST, WOT 12TH FL, WORCESTER, MA 01605-2038
(508) 368-5532
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
ME0053894
FL
207Q00000X
Family Medicine Physician
Primary
262412
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07463
BLUE CROSS PROVIDER NUMBE
FL
Enumeration date
07/01/2006
Last updated
10/19/2015
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