Provider Demographics
NPI:1326171810
Name:TEDESCO, BETH BOSTON (DC)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:BOSTON
Last Name:TEDESCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14804 PHYSICIANS LANE SUITE 222
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-424-0220
Mailing Address - Fax:301-424-7262
Practice Address - Street 1:14804 PHYSICIANS LANE SUITE 222
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-424-0220
Practice Address - Fax:301-424-7262
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor