Provider Demographics
NPI:1568626778
Name:KAPTCHUK, TED J (LIC AC)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:KAPTCHUK
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BAY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3145
Mailing Address - Country:US
Mailing Address - Phone:617-354-1744
Mailing Address - Fax:
Practice Address - Street 1:OSHER INSTITUTE/HARVARD MED SCHOOL
Practice Address - Street 2:401 PARK DRIVE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-354-1744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist