Organization
MEDICAL CENTER WEST PODIATRY ASSOCIATES, INC.
Active
Organization
MEDICAL CENTER WEST PODIATRY ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN F. KETCHUM D.P.M. (PRESIDENT)
(508) 755-9573
Entity
Organization
Contact information
Practice address
488 PLEASANT ST, WORCESTER, MA 01609-1857
(508) 755-9573
Mailing address
126 BUSHY LN, RUTLAND, MA 01543-2025
(508) 886-6280
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
2087
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
719907
TUFTS HEALTH PLAN
MA
05
—
9719067
—
MA
01
—
W201440
CIGNA
MA
01
—
Y77039
BLUE SHEILD OF MA
MA
Enumeration date
10/06/2006
Last updated
03/25/2008
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