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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