1740960574 NPI number — BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC

Table of content: (NPI 1740960574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740960574 NPI number — BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1740960574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 NORTH AVE
Provider Second Line Business Mailing Address:
DOOR 17
Provider Business Mailing Address City Name:
WAKEFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-944-4044
Provider Business Mailing Address Fax Number:
781-944-4050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 MAIN ST UNIT 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-459-8760
Provider Business Practice Location Address Fax Number:
603-459-8758
Provider Enumeration Date:
07/18/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ANTIMONE
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
781-944-4044

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0131X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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