Provider Demographics
NPI:1114981487
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:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-944-4044
Mailing Address - Street 1:30 NEW CROSSING ROAD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3271
Mailing Address - Country:US
Mailing Address - Phone:781-944-4044
Mailing Address - Fax:781-944-4050
Practice Address - Street 1:30 NEW CROSSING ROAD
Practice Address - Street 2:SUITE 311
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3271
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:2006-04-13
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA68868OtherTUFTS HEALTH CARE
MAY77328OtherBLUE CROSS/BLUE SHIELD
MA68868OtherTUFTS HEALTH CARE
Y78059Medicare ID - Type Unspecified