Provider Demographics
NPI:1609920776
Name:TREIBICK, THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:TREIBICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ELK RUN RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3542
Mailing Address - Country:US
Mailing Address - Phone:978-505-9897
Mailing Address - Fax:855-870-4649
Practice Address - Street 1:101 CAMBRIDGE ST STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3769
Practice Address - Country:US
Practice Address - Phone:781-272-9500
Practice Address - Fax:855-870-4649
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46320207RA0401X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110002031Medicaid
1609920776OtherWELLSENSE HEALTH PLAN160
703314OtherTUFTS
70010000B12009OtherBCBSMA