Provider Demographics
NPI:1932213899
Name:VAN ESS, GREGORY M (DPM)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:VAN ESS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:81 HIGHLAND AVE
Mailing Address - Street 2:NORTH SHORE HEALTH SYSTEMS
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-354-4173
Mailing Address - Fax:
Practice Address - Street 1:9 WARREN COURT
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3168
Practice Address - Country:US
Practice Address - Phone:978-744-1309
Practice Address - Fax:978-744-3783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2119213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY71059OtherBLUE CROSS
MA0362131Medicaid
MA480028403OtherRAILROAD MEDICARE
MA333014OtherTUFTS
MA480028403OtherRAILROAD MEDICARE
MA0362131Medicaid