1588628853 NPI number — BRIAN D TEDESCO D.P.M.

Table of content: BRIAN D TEDESCO D.P.M. (NPI 1588628853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628853 NPI number — BRIAN D TEDESCO D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEDESCO
Provider First Name:
BRIAN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588628853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-7190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-231-7026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOMERVILLE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02145-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-629-2304
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  2199 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X , with the licence number: 2199 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0364011 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0032245 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11318840 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202648900 . This is a "DEPT. OF LABOR-WC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 972127 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2180343 . This is a "HEALTHCARE VALUE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2180343 . This is a "FIRST HEALTH-MA LABORERS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 334226 . This is a "HARVARD PILGRIM HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 746579 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 002199 . This is a "TUFTSHEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 96048 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: DB4378 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y71104 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com