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SIGNATURE MEDICAL GROUP
NPI 1962686329
Podiatrist - Foot Surgery in Brockton, MA

Active since December 20, 2007
110 LIBERTY ST, BROCKTON, MA 02301(508) 894-0400(508) 565-0157 Get Directions Write a Review

NPPES record last updated: May 23, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Signature Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SIGNATURE MEDICAL GROUP (NPI 1962686329) is a healthcare organization registered as a foot surgery in Brockton, Massachusetts and active in the NPI registry since December 2007. The organization lists Kim Hollon, Ceo, as its authorized official.

NPPES Registry Identity

NPI1962686329
Entity TypeOrganization
Primary Taxonomy213ES0131X
Legal Business NameBRIDGEWATER GODDARD PARK MEDICAL ASSOCIATES PODIATRY DIVISION
Location Address110 LIBERTY STBrockton, MA 02301-5521
Mailing Address110 Liberty StBrockton, MA 02301-5521 · (508) 894-0400 · Fax (508) 565-0157
Phone(508) 894-0400
Fax(508) 565-0157
Organization SubpartNo
Authorized OfficialKim HollonCeo · (508) 941-7004
Enumeration DateDecember 20, 2007
Last NPPES UpdateMay 23, 2012
✔ NPI 1962686329 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0131X
License✔ Licensed in MA · 1715
110 LIBERTY ST, Brockton, MA 02301
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Other Names 1

Doing Business AsSignature Medical Group

Other Identifiers 2

Medicare PINM20452MA
Medicaid110022141EMA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. RICHARD DUONG PA-C
Physician Assistant
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
MRS. RENA B LEVY MSN, FNP-BC
Nurse Practitioner (Family)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. KEVIN RAYMOND GENDREAU M.D.
Family Medicine (Obesity Medicine)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
XIN HE
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. SENA J LEE MD
Dermatology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 580-1020
NITA MEHTA MD
Ophthalmology
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400
DR. TARA SAMANTHA SWIM M.D.
Physical Medicine & Rehabilitation
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 565-3055
NATASHA BITA KHAZAI MD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
110 LIBERTY ST
BROCKTON, MA 02301
Plymouth County (508) 894-0400

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bridgewater Goddard Park Medical Associates Podiatry Division's NPI number?

The NPI number for Bridgewater Goddard Park Medical Associates Podiatry Division is 1962686329. It was assigned to this organization in the NPPES registry on December 20, 2007. The provider is doing business as Signature Medical Group.

Where is Bridgewater Goddard Park Medical Associates Podiatry Division located?

Bridgewater Goddard Park Medical Associates Podiatry Division is located at 110 Liberty St, Brockton, MA 02301. The listed phone number is (508) 894-0400.

What is Bridgewater Goddard Park Medical Associates Podiatry Division's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot Surgery, with taxonomy code 213ES0131X.

When was this NPI record last updated?

The NPPES record for Bridgewater Goddard Park Medical Associates Podiatry Division was last updated on May 23, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.