Provider Demographics
NPI:1902356587
Name:BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC
Entity Type:Organization
Organization Name:BRIAN D TEDESCO, DPM & GEORGE A ABBOUD, DPM PC
Other - Org Name:NEW ENGLAND FOOT & ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANTIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-245-6995
Mailing Address - Street 1:10 RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2913
Mailing Address - Country:US
Mailing Address - Phone:781-245-6995
Mailing Address - Fax:781-245-6031
Practice Address - Street 1:30 NEW CROSSING RD
Practice Address - Street 2:SUITE 311
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3270
Practice Address - Country:US
Practice Address - Phone:781-944-4044
Practice Address - Fax:781-944-4050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y78078Medicare PIN